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Chapter 4 - Avoiding Distress

from Part II - Case Studies

Sophia Xenophontos
Aristotle University, Thessaloniki


Chapter 4 examines Galen’s credentials as an ethical philosopher in the light of his recently discovered essay Avoiding Distress. It argues that his moral agenda which is expanded upon here makes him an active participant in the practical ethics of the High Roman Empire, with a more profound attentiveness to popular philosophy than is usually admitted. Galen’s dialogue with what has been termed ‘Stoic psychotherapy’ and the Platonic-Aristotelian educational model helps build up his ethical influence through an engagement with the past. On the other hand, his individual characteristics, such as the autobiographical perspective of his narrative and the intimacy established between author and addressee, render Avoiding Distress exceptional among essays (whether Greek or Latin) treating anxiety, especially when compared to the tracts on mental tranquillity written by Seneca and Plutarch. Another distinctive element of the treatise is that Galen’s self-projection as a therapist of the emotions corresponds to his role as a practising physician as regards the construction of authority and the importance of personal experience.

Publisher: Cambridge University Press
Print publication year: 2024
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Mortals have no other medicine for distress
Like the advice of a good man, a friend
Who has experience with this sickness…
(Οὐκ ἔστι λύπης ἄλλο φάρμακον βροτοῖς
ὡς ἀνδρὸς ἐσθλοῦ καὶ φίλου παραίνεσις.
ὅστις δὲ ταύτῃ τῇ νόσῳ ξυνὼν ἀνὴρ…)
Euripides, fragm. 1079; Kannicht, TrGF vol. 5, p. 1010
The man who is sick in the body needs a doctor;
Someone who is sick in the soul needs a friend;
For a well-meaning friend knows how to treat distress.
(Τῷ μὲν τὸ σῶμα διατεθειμένῳ κακῶς
χρεία ᾽στ’ ἰατροῦ, τῷ δὲ τὴν ψυχὴν φίλου·
λύπην γὰρ εὔνους οἶδε θεραπεύειν φίλος.)
Menander, fragm. 865; PCG vol. VI 2, p. 409

The unexpected discovery of the Vlatadon 14Footnote 1 in 2005 brought to light Galen’s long-lost treatise Avoiding Distress.Footnote 2 This text is part of Galen’s ethical writings,Footnote 3 as seen above, and offers a magnificent testimony to the therapy of lypē in the ancient world.Footnote 4 When giving advice on the treatment of this same passion in one of his medical works, the Therapeutics to Glaucon, Galen suggests introducing the patient to the direct opposite of the condition that troubles him (πειρᾶσθαι δὲ καὶ τὸ ἐναντίον ἀντεισάγειν ἀεὶ τῷ λυπήσαντι), meaning in this case treating him with ‘gladness of heart (θυμηδίαν) in words, deeds, sights and descriptions’ (MMG 1.3, XI.16.5-9 K.).Footnote 5 This sort of distraction therapy, grounded in allopathy,Footnote 6 a mainstay of Galenic therapeutics for both bodily and mental disturbances, is not like most of the advice Galen offers in Avoiding Distress.Footnote 7 And that is a primary indicator that in this work our author steps away from the role of the therapist, who alleviates mental disorder through psychotherapeutic protocols that would have been beyond the ken of non-medical experts. By contrast, he puts on the mantle of the ethicist, who instructs on the management of everyday emotions through philosophical means accessible to all.

Avoiding Distress has been the subject of a large amount of learned commentary, because it provides valuable information about the production and publication of ancient books and the holdings of Imperial libraries.Footnote 8 Others have considered it an important source for adding to our knowledge of Commodus’s cruel regime (180–192 AD)Footnote 9 or because it elucidates aspects of Galen’s life, which we can use as a control on the unreliable Arabic biographies.Footnote 10 Finally, some other studies have yielded valuable insights into Galen’s philosophical allegiances, particularly in connection with the tradition of ethical writing, but they tend to limit themselves to identifying philosophical positions and arguments, largely neglecting the literary and rhetorical strategies through which Galen’s project on emotional resilience is realised in the text for the moral benefit of the reader; at best these issues are treated in piecemeal fashion.Footnote 11

The aim of this Chapter is to examine Avoiding Distress as a holistic literary composition. To that end, it will focus on its content, internal structure and narrative setting, in order to bring out the distinctive characteristics of Galenic ethics and evaluate how it worked and the impact that it seems Galen hoped it would have on contemporary society. This Chapter also seeks to demonstrate that Avoiding Distress is a unique source in respect of Galen’s identity as an ethical adviser and, similarly, in respect of the sophisticated devices he puts in place to promote his moral didacticism. Some of the key topics to be addressed are Galen’s departures from other moralists who have treated the issue of distress (notably Seneca, Epictetus and Plutarch) and the extent to which Galen’s moralism is informed by the (rhetorical) methods he applies in his medical accounts directed at the treatment of the body. Moreover, given that Galen’s Avoiding Distress is the only extant work peri alypias,Footnote 12 it may help us to get some idea of the potential content of other, now lost, essays on this topic.

Generic observations and individual features

Avoiding Distress is a letter-essay in response to a request from an anonymous friend.Footnote 13 The correspondent is astonished at Galen’s moral fortitude in the face of the calamity of the great fire on the Palatine Hill in Rome in 192 AD and is eager to find out the philosophical mechanisms that allowed him to maintain his self-control.Footnote 14 The dating of the treatise to the early months of 193 AD shows how the recollection of the disaster would have still been fresh in people’s minds – a revived reality, as I shall argue – for both writer and addressee.Footnote 15

The thematic framework makes it clear from the outset that this is an essay with moralising intent, belonging to the popularised genre of practical ethics.Footnote 16 In referring to more specific typological distinctions between works of ethical philosophy, Philo of Larisa (158–84 BC), once head of the Platonic Academy, established a threefold categorisation: a) protreptic works guiding towards morally adept attitudes and encouraging therapy, b) therapy applying philosophical guidance to particular cases of the treatment of emotions by eliminating false beliefs and c) advice proposing lifestyles through which happiness could be achieved by means of some therapy that has already been applied.Footnote 17 It is in the category of ‘therapy of emotions’ (b) that Avoiding Distress best fits, though it may also intersect with the protreptic (a) and the advice on appropriate lifestyles (c), issues to which I will return in the main part of this Chapter. On the other hand, the essay’s prescription for achieving freedom from lypē has led some scholars to associate it with the genre of the consolation,Footnote 18 from which, strictly speaking, Avoiding Distress differs in a number of respects. Firstly, it does not involve the loss of a loved one or (a less frequent subject) exile as the cause of the distress, but rather material deprivation; secondly, it is not addressed to a person who is currently mourning some loss, but to a philosophically minded enquirer seeking remedies for regaining equanimity in case of need.Footnote 19

What renders Avoiding Distress rare among mainstream works of practical ethics is that the moral instruction professed is enhanced throughout with autobiographical touches that result in a lively sort of moralising.Footnote 20 The therapy on offer, visualised through a very personal lens, helps consolidate Galen’s authority as a moralist, because it shows that his prescriptions are based on advice that has already been tested and proved successful. On another level, the tranquillity that Galen (as narrator and author) embraces, as opposed to the expected feeling of perturbation, puts him in position to manipulate his audience’s emotional responses during the process of reading, as we shall see.Footnote 21

The construction of authority in the preface, Or how to become a moral hero

In the preface of an epistolary tract the author traditionally mentions the motive for composing his work. The Galenic narrator (or ‘Galen’) starts by claiming that his correspondent’s letter had requested information on the kind of training, arguments and considerations that had made Galen immune to distress. The choice of letter form helps to underline how the core message of the treatise (how to achieve immunity from distress) responds to the psychological needs of its addressee, and so exemplifies what is, in Christopher Gill’s analysis, one of the salient features of ancient therapeutic writing.Footnote 22 Whether we see the work’s form as a literary convention or indeed an element of the core strategy of the therapeutic genre in line with Gill, it also has implications for Galen’s claim to expertise in practical ethics. I find it striking that, in reproducing the content of his friend’s letter, ‘Galen’ chooses to disclose only some specific points.

According to ‘Galen’, the friend had himself been present and had observed (ἑωρακέναι, Ind. 1, 54.3 PX; cf. ἑωρακέναι, Ind. 1, 54.6 PX) Galen’s tranquillity when the latter lost his slaves in the Antonine plague. Additionally, he had heard (ἀκηκοέναι, Ind. 1, 54.4 PX) that Galen had suffered from similar setbacks in the past. The narrator also tells us that his correspondent now had a clear appreciation of the losses caused by the fire (αὐτὸς ἔφης ἐπίστασθαι, Ind. 1, 54.9-10 PX) and that an informant had told him (πεπύσθαι δέ τινος ἀγγέλλοντός σοι, Ind. 1, 54.10 PX) that Galen was not grieved but was cheerfully continuing his normal activities.

The verbal forms of observation and cognition reinforce the credibility of Galen’s account. His claim to have retained his equanimity in the face of a range of distressing events is backed up by external evidence, by trusted third parties who had personally encountered him and now provided objective reports.Footnote 23 Galen’s management of distress attracts the attention of those around him and leads to his being seen as a moral exemplar. The process whereby Galen is elevated to this status begins with the narrator’s detailed enumeration of his losses, itemised in ascending order from the relatively minor to the more substantial, thus stressing the degree of deprivation. He lists many gold and silver plates, but also his drugs (both simple and compound) as well as his medical instruments; then, the editions of ancient authors he had prepared and his own compositions; finally and most importantly, a rare collection of antidotes, among which the famous ‘theriac’ and cinnamon which Galen possessed a very great deal of at a time when it was extremely difficult to get hold of them (Ind. 1, 54.11-56.24 PX).

By confronting the destruction of those treasures with imperturbability, Galen excites his correspondent’s amazement (θαυμάζειν, Ind. 1, 54.11 PX). Amazement leading to admiration of a moral exemplum was a basic component of moral learning in the history of ethics, forming ‘a responsive stage of arousal’ before the ‘next active stage of emulation’, cognition and discernment.Footnote 24 In context, amazement supports Galen’s claim to moral heroism and his self-projection as a paragon of magnanimity to other people. Αs Galen, drawing on Chrysippus (fragm. 876 SVF), explains in Affected Places, magnanimity makes its practitioners rise far above lypē and other fiercer passions, because their mental strength (τόνος τῆς ψυχῆς) is greater than their passions, which are insignificant (τὰ παθήματα σμικρά, Loc. Aff. 5.1, 288.28-290.3 Brunschön = VIII.302.2-5 K.). The same passage sets the magnanimous individual (ἀνὴρ … μεγαλόψυχος) apart from other people who, by contrast, can die of lypē (ἔνιοι καὶ διὰ λύπην ἀπέθανον Loc. Aff. 5.1, 288.27-28 Brunschön = VIII.302.1 K.).Footnote 25 This brings to mind Aristotle’s view that magnanimity is a virtue for the few, being an ‘adornment of the virtues’ (Nicomachean Ethics 1124a1). The distinction between people who are magnanimous and those who are not, found in Affected Places, seems to inform the intertext in Avoiding Distress, since the magnanimous Galen is here contrasted with Philides the grammarian (about whom the correspondent had also been informed, πεπύσθαι, Ind. 1, 56.24 PX): facing the loss of his books in the same fire, Philides subsequently died of depression,Footnote 26 surrounded by black-clad mourners (Ind. 1, 56.27-28 PX).Footnote 27 The death scene is juxtaposed to the joyful countenance (φαιδρόν, Ind. 1, 54.10 PX) with which Galen withstood the distress described above and this ultimately endorses his suitability to write a treatise on cheerfulness and the treatment of distress.Footnote 28

Another key issue arising from the proem concerns the role in the text of the addressee, who is meant to participate not just as a witness to the loss of Galen’s material goods, but also because of his personal rapport with the narrator. By reconstructing the addressee’s letter, the Galenic narrator offers a clear glimpse of how the two men share common reminiscences and explains that their epistolary communication thus advances the exchange of knowledge and ideas. Later on in the text the close relationship between the two men is reflected in the description of the social credentials of Galen’s friend, which so much resemble his own: he is a fellow Pergamene, of the same age as Galen (i.e. both now in their mid sixties), they have known each other from childhood, attended school together and enjoyed the same liberal education (ἐξ ἀρχῆς συναναστραφεὶς καὶ συμπαιδευθείς, Ind. 12, 78.2-3 PX; σὺ παιδευθεὶς σὺν ἡμῖν, Ind. 13, 80.5 PX). Having spent some time in Rome, the friend embraces Galen’s political perspective on Commodus’s politics (Ind. 12, 78.16-80.20 PX) and, although they now live miles apart, they have maintained a close friendship for many years.Footnote 29 Therefore Galen’s personal misfortune is expected to be a familiar matter to the addressee, making its recollection and the quest for ethical equilibrium also something that concerns both of them. Galen is not a distant, bookish preacher, but an intimate and pragmatic moral advisor.

The deliberate introduction of personality into the narrative might be explained in the light of Galen’s moral programme in his Character Traits: the aim of the virtuous person is to reform his own soul in order to reform the souls of all the other people over whom he has influence, one by one, beginning with those closest to him. This he will achieve by teaching them by precept what they ought to do and by making himself a role-model for them (De Mor. 39 Kr.). This pattern of Galenic moral reform coincides with Michel Foucault’s view of how the care of the Self grounded in psychosomatic well-being can become a means of helping the Other, and how a preoccupation with the particularity of the Other facilitates moral treatment and progression. In Avoiding Distress, the care of the Self is elucidated through Galen’s autobiographical introspection, and the particularity of the Other explained by the addressee’s long-standing acquaintance and emotional relationship with the author. As Foucault further stresses, works of the Principate that are primarily concerned with the interplay between the care of the Self and helping the Other build on ‘pre-existing relations’ between author and reader and cause an ‘intensification of existing social relations’,Footnote 30 ideas that are completely in line with Galen’s understanding of the moralising power of friendship in Avoiding Distress.

On another level, Galen’s self-presentation as an ethical authority in the tract resembles his self-projection in his medical case histories. Those embedded clinical encounters do far more than just explore the stages of the diagnosis, treatment and prognosis of the diseases of particular patients (on which more in Chapters 7 and 8). They attest to Galen’s superiority as a physician, reanimating through auto-recollection the reactions of his peers to his medical performances.Footnote 31 The most common response was amazement.Footnote 32 In one of Galen’s most fascinating texts, Prognosis, the Peripatetic philosopher Eudemus admires Galen and advertises his medical competence to high-ranking figures in Rome,Footnote 33 while elsewhere Galen attracts admiration of the Imperial circle by curing the young emperor.Footnote 34 Similarly, Galen’s medical efficacy is backed up by the addressee’s own confirmation of the former’s claims (the frequent aside ‘as you very well know’),Footnote 35 as someone who has been constantly present during the performances. Finally, although the author is portrayed as an exceptional physician, he is never isolated from his social circle, which includes a range of teachers, patients and physicians. The communal experiences he shares with his addressee, Epigenes, in particular and the direct interaction between the two expressed in the use of the sociative ‘we’, make Galen’s medical narration a social rather than a private act.Footnote 36 A similar collaborative approach informs Avoiding Distress, suggesting that in transmitting his personal ethical assertions, Galen is not alone, but at the very heart of his surroundings, a philosopher embedded in society. I will return to this point below.

When Galen was composing his Avoiding Distress, essays on psychic tranquillity were already in circulation, for instance, by Democritus and Panaetius (now lost), and by Seneca and Plutarch. More specifically, Plutarch’s preface to his own Tranquillity of the Soul offers a good comparandum regarding the construction of authority and the relation between author and addressee in such moral contexts. This is an epistolary essay too, which Plutarch addresses to his Roman friend Paccius in response to the latter’s request for a treatise on emotional resilience. In this case, Plutarch bases his ethical potential not on his moral experiences,Footnote 37 like Galen, but on the philosophical material he is able to elaborate in written form: a work of practical ethics after direct consultation of his personal note-books (hypomnēmata) on the one handFootnote 38 and an exegetical commentary elucidating some thorny passages from Plato’s Timaeus on the other (De Tranq. Anim. 464 E-F). In the rest of the essay, Plutarch is lecturing, seeking to mould his addressee’s behaviour. For instance, he praises Paccius for not succumbing to the evils of fame, and prizing social standing (De Tranq. Anim. 465A) and elsewhere castigates him on suspicion of self-interest and overindulgence (De Tranq. Anim. 468E). As a character in the narrative Paccius gradually fades away and becomes a constructed substitute for a larger audience enjoying Plutarch’s moral advice. That is not quite the case with Galen’s anonymous friend, who is cast as being closely attached to the author throughout the narrative in such a way that the plot makes sense as long as the anonymous friend remains an essential part of what we read. That Paccius’s role in not as vital as that of Galen’s friend might also be seen in the fact that Plutarch’s essay is not context-specific, in the fashion of Avoiding Distress, but concerned with a large number of situations that could generate distress.

In Seneca’s On the Tranquillity of the Soul the author is also depicted as a qualified philosophical teacher, who provides his addressee, Annaeus Serenus, with a sequence of precepts to be adopted.Footnote 39 Epictetus is a similar case in point, since his Discourses and Manual (as preserved by his pupil Arrian) communicate to his fragile young students his ethical lessons through imperatives and hortatory subjunctives.Footnote 40 This aligns Epictetus’s didactic style with Maximus of Tyre’s exhortatory perspective that ‘the summit of philosophy and the road that leads to it demand a teacher who can rouse young men’s souls and guide their ambitions’ (Oration 1.8). Of course, the authoritative pedagogy practised by these philosophers does not resemble Epicurus’s coercive therapy.Footnote 41 But it is nevertheless in stark contrast to the intrinsically co-operative relationship between author and addressee in Avoiding Distress that underlies the therapy of distress, in line with the message of the two poetic quotes opening this Chapter.

The revived reality of the loss

We have seen in the previous section that ‘Galen’ refers to Philides the grammarian, who died of distress at the loss of his books. Apart from functioning as an example to be avoided, this incident helps to reperform the public response to the fire. ‘Galen’ reports that most people stored their possessions in the Temple of Peace, having complete confidence (expressed with the recurrent cognates of θαρρεῖν, Ind. 1, 56.28 PX, 1, 56.30 PX; 1, 58.35 PX) that the repositories were fireproof. The tragic overturning of their expectations gives rise to their disappointment, to which Galen did not subscribe.

In a new section he stresses that, apart from the general disaster, Galen alone had suffered a personal misfortune (ἴδιον, Ind. 1, 58.36 PX) that was all the more discomfiting: as he was about to visit his estate in Campania, he had decided to store all his valuables in the repositories to keep them safe, but instead he found that everything had been destroyed. Even so he was not upset even for a moment, and this purportedly motivated the addressee to request a first-hand account of the event from Galen, although he had already learnt about it through witnesses, as noted above. By virtue of his emotional aloofness from common reactions and his addressee’s acknowledgment of his exceptionality, Galen gives his reader a sense of security; and, as the narrative progresses, he reconstructs a blow-by-blow description of the loss (more extensive and systematic than the one we have seen in the preface), meant to incite a feeling of retrospective distress in the reader. The author reforms his addressee’s behaviour by assigning him specific thoughts and corresponding emotional reactions. These manipulative strategies take the form of asides in the second-person singular and are akin to what we nowadays call the power of ‘suggestion’, a term coined by nineteenth-century psychologists such as William James.Footnote 42

The asides start to appear at the juncture where we pass from the past tense, in which the correspondent’s epistle was reported, to the present tense, in which ‘Galen’ now focuses on the after-effects of the loss. He plainly says that even today he can feel the loss of all those things that were essential to his practice every time he needed a book, instrument or drug (μέχρι νῦν αἰσθάνομαι καθ᾽ ἑκάστην ημέραν, Ind. 2, 58.7-8 PX); and directly ‘suggests’ a first thought to his friend: ‘But in fact the most dreadful matter (δεινότατον) associated with the loss of the books has escaped you (λέληθέ σε), and there is no hope (μηδὲ ἐλπίδα) of recovery remaining, since all libraries on the Palatine were burned to the ground on that day’ (Ind. 2, 58.9-11 PX). In the reproduction of the friend’s letter, ‘Galen’ allowed some hope for the recovery of his medical instruments, although he was clear that this would take a significant amount of time and effort (Ind. 1, 56.18-19 PX), whereas in this case the elimination of any hope transposes a sense of retrospective despair to the addressee:

It is accordingly impossible to find not only works that are rare or unavailable from another source, but also the common ones that were eagerly sought out for the precision of their text, those of Callinus, Atticus, Peducaeus and of course Aristarchus, by whom are the two Homers, and also the Plato of Panaetius and many other such writings … For in fact autograph copies of many ancient grammarians, orators, physicians and philosophers were stored there.Footnote 43

Ind. 2, 58.11-60.18 PX

The valuable legacy to posterity has been burned to ashes, but Galen’s narration becomes even more powerful when he claims that, in addition to the numerous books, he lost that day his own recent editions, which were so carefully arranged that ‘not even a single or double marginal mark or a coronis suitably placed between books’ (Ind. 3, 60.3-6 PX) had been destroyed. In that category belonged the works of iconic figures of Graeco-Roman philosophy and medicine (Ind. 3, 60.8-62.10 PX). The emphasis on the diligent and time-consuming textual preparation of important works augments the emotional impact of the loss.

The same pattern recurs later in the text; a reference to a group of perished intellectual treasures is accompanied by two manipulative asides, which now stir up not the idea but the emotion of distress itself: ‘Above all, however, you will be distressed by the fact that, (Λυπήσει δέ σε καὶ ταῦτα μάλιστα) beyond the books recorded in the so-called Catalogues, I found some in the Palatine libraries …’ (Ind. 3, 62.10-12 PX), by which Galen means that he had come across rare works of limited circulation that had also now disappeared for ever. In similar fashion: ‘Perhaps you were also distressed (Ἴσως δὲ ἐλύπει) by the unfortunate outcome of my treatise on Attic nouns and collections of everyday language’, a work comprising two parts, one drawn from old comedy and the other from prose-writers (Ind. 5, 64.1-3 PX).

In order to increase the reader’s anxiety with variations on a theme, Galen now adduces the role of fate (tychē), a traditional topic in ethical works of the post-Hellenistic period, which is also addressed in his Exhortation to the Study of Medicine (Protr. 2-4, 85-88 B. = I.3-6 K.), as we will see in the next Chapter. Fate is a media vox, sometimes known for its benevolence and at others for the unexpected blows that plague human life, hence showing the need for philosophical instruction as a protective medium. Galen, so he tells us, had made copies of all his works intended for distribution, but had by chance (κατὰ τύχην, Ind. 5, 64.3 PX; cf. κατὰ τὴν τύχην, Ind. 7, 68.3 PX) only transposed to Campania his work on prose-writers, which was saved. His remark that the same fate that had favoured him also ambushed him (ἐνήδρευσεν οὖν ἡμᾶς ἡ Τύχη, Ind. 5, 66.14-15 PX) brings us one step closer to the emotional climax and leads Galen to linger on the loss of his study of the vocabulary of old comedy, explaining the significance of which takes him no less than two whole paragraphs (Ind. 6, 66.1- 7, 68.5 PX).

In contrast to the feeling of distress with which the addressee is now afflicted, ‘Galen’, describing his own emotional state, reiterates that none of these losses had grieved him (Τούτων οὖν οὐδὲν ἠνίασέ με, Ind. 7, 68.5 PX; ἀλλ᾽ οὐδὲ ταῦτα ἐλύπησεν, Ind. 7, 68.10 PX), although they were substantial and hard to replace, not even the destruction of his hypomnēmata and a large number of medical and philosophical works. The affective gap between the two parties produces a state of complete amazement in both the primary and the secondary audience: ‘What on earth, you will say; is even greater than all the items mentioned that could cause distress? Well, I shall tell you what this is.’ (Ind. 8, 68.1-2 PX).Footnote 44 Galen was convinced that he possessed the most remarkable drug recipes in the Roman world, brought to him by a twofold fate (Διττή … τύχη, Ind. 8, 68.5 PX). His rhetorical question, however, and more especially his assertive ‘I will tell you’ at the end of the quote, are misleading, as we do not, in fact, get any answer as to whether the loss of his drug collections upset him or not. Instead, Galen redirects the questions ascribed to his addressee, who no longer cares which of the many disasters would have aroused the most distress in Galen (obviously none of them!), but only why he was not grieved like other men at the loss of such a great variety of possessions (Ind. 9, 72.5-8 PX). Therefore, prima facie, Galen’s moral heroism in the rhetorical question quoted above borders on self-praise, but on closer inspection it actually emphasises his emotional resilience, so that it acts as a therapeutic strategy in the interests of his reader’s moral progress. The text is by itself a suggestive entity, conveying to the reader the idea that the authorial self is a unique role model among his contemporaries, whereas the reader will himself become one of those ‘Others’ troubled by distress unless he follows Galen’s lead. Galen, as a soul doctor, has helped the reader develop an introspective consciousness of his own psychic frailty and shown him, as a critical entity, his pressing need for therapy.

Traditional instruction and Galen’s ethics

In a new section of the essay, Galen exploits the repertory of moral instruction familiar from the works of other moralists. One notices, for instance, the use of moral anecdotes and quotations from authorities, to which Galen adds individual twists. His place in the legacy of moralia is confirmed by the reminder he puts in the mouth of his addressee that the latter has heard him expounding similar ethical pronouncements many times in the past (Ind. 9, 72.9-11 PX).Footnote 45

The moralising part starts with Aristippus of Cyrene, an important follower of Socrates, who became proverbially known in works of ethics for his self-gratification. Aristippus also appears in Plutarch’s Tranquillity of the Soul 469C-D, where he is an example of a wise man rising above the unpleasant conditions of life.Footnote 46 In contrast to Plutarch, Galen recounts two anecdotes about Aristippus that point to the importance of self-sufficiency and hence to the idea that the loss of wealth should not be a matter for sorrow. Furthermore, Galen intertwines the moral of the anecdote about Aristippus with his own ethical voice, when he declares that he shares Aristippus’s point of view:

[H]e (i.e. Aristippus) nicely demonstrates what you heard me say many times, namely that one should not focus on anything that has been lost, but rather consider how those who have inherited three fields from their father will not bear to look at others with thirty.Footnote 47

Ind. 10, 74.11-15 PX

Galen offers mind-control techniques that secure happiness: i.e. that we should refrain from having too many desires which can hardly ever be satisfied, and should be content with what is sufficient to life, both stances akin to what we call ‘attitude of gratitude’ in modern psychologyFootnote 48 and which go as far back as Epicurus.Footnote 49 Galen’s advice becomes more appealing when he provides moral evaluation of what is considered ethically admirable (Ind. 10, 74.25 PX).Footnote 50 To his mind, the magnanimous person is not the one who is not distressed at being left with three fields, but the person who is destitute and still bears his poverty without distress, such as Crates, Diogenes and especially Zeno, who also represents a model of self-sufficiency in Plutarch’s account (De Tranq. Anim. 467C-D).Footnote 51

Galen has so far employed commonplaces to present his moralising in a protreptic fashion, but again a personal note creeps into the discussion. He explains in two instancesFootnote 52 that it was not such a great thing for him to despise the loss of his possessions, because he was always left with much more than he needed. By the same token, it was not important that he had not prized his position in the Imperial court (Ind. 11, 76.11-14 PX), or that he had lost all his drugs, books and recipes, and the writings on them he had prepared for publication along with many other treatises (Ind. 11, 76.14-19 PX). The recapitulation of his losses in reverse order here is not simply a textual reminder, but an ethical strategy with more complex connotations. We have seen in a previous section that, on his return to Rome, Galen came to realise every day the importance of the loss and found himself in need of particular books, instruments or drugs. All these things he now considers superfluous, judging by his particular use of the participle καταφρονήσαντι (‘having despised’) echoing the Stoic belief in ‘indifferents’:Footnote 53 the only thing that determines happiness is virtue, and everything else, including wealth, health, fame and social prominence, are moral indifferents, factors that cannot affect individual happiness.Footnote 54

Galen’s philosophical spirit is practical rather than theoretical, especially in instances such as these in which he speaks as a social critic, aiming at correcting the deviant morals of those around him. Second-century Graeco-Roman society is often seen – and was seen at the time – as a profoundly competitive one, in which personal elevation became an end in itself, very often ignoring the weight of morality. In the introduction to his Prognosis, the two proems to the Therapeutic Method and his Recognising the Best Physician, all of which to some extent take the form of ethical diatribes,Footnote 55 as we shall see in other parts of this book, Galen comments on the degeneracy of his times and criticises in particular the corruption that afflicted physicians in Rome.Footnote 56 He frequently expresses his desire to abandon the capital and move back to his native town, which he paints in a more positive light. The distinction he makes between Rome and the Greek East is symptomatic of Galen’s pride in being a Hellene, a topical issue in Second Sophistic discourse, especially when it came to the responses of Greek intellectuals to Roman rule.Footnote 57 We will see below that Galen criticises Commodus’s rule, whereas we have already observed that Galen’s correspondent in this case is a fellow Pergamene and not a Roman dignitary, like Plutarch’s Paccius. That said, the moral dimension of geographical space in Galen is also critical, as I will argue in Chapter 8.

Now, it is important to note that in Galen’s public debate in Avoiding Distress, designed to advise contemporary readers, he borrows convenient terms or adopts individual tenets and strategies from Stoicism (despite his general hostility to Stoic psychology),Footnote 58 because this was considered a very fully worked out kind of philosophy, a way of life, and hence one that suited his pragmatic spirit. Galen, for instance, suggests a method of preparing for future evils (praemeditatio futurorum malorum), one of the fundamentals of Stoic psychotherapy and shared with the Cyrenaics, according to which the anticipation of traumatic experiences might lead to an increased ability to endure them when they happened.Footnote 59 Although this meditative practice seems to be a point of contention among philosophers – Epicurus, for example, claimed that distress is either bearable or short and that we should thus not aggravate it by focusing on its imagined visualisationFootnote 60 – Galen is openly in favour of it (Ind. 12, 78.8-13 PX).Footnote 61 Again the moralising is not simply thrown at the addressee as an injunction to adopt without further consideration, but it becomes a vital element in their common experiences. The addressee is actively involved in the narrative when ‘Galen’ reminds him of the crimes committed by Commodus and how his political fears had schooled Galen’s imagination (ἐγύμνασά μου τὰς φαντασίας, Ind. 12, 80.20 PX) and prepared him for the total loss of all his possessions. Τhe notion of φαντασία again goes back to the Stoics, generally referring to the impressions that are created in the mind when the senses are stimulated by external phenomena. Thus ‘Galen’ advises his friend to practise using his own imagination too (ἀσκεῖν παρακελεύομαι τὰς φαντασίας σου τῆς ψυχῆς, Ind. 13, 80.2 PX) by anticipating being confronted with the possibility of exile, a common threat during the reign of Commodus. Here Galen is certainly addressing a larger group of people too, who must have been aware of the capricious politics of the Roman emperor, and giving them practical ethical means to withstand the possible dangers deriving from his oppression.

The practical tone of Galen’s ethics is not the product of Stoic influences or social commentary alone, but also of his personal experience. Around the end of the essay, ‘Galen’ raises a central issue in ancient ethics when he claims that his training of the imagination was based on a combination of proper natural propensities and excellent education (Ind. 13, 80.3-5 PX). This gives him the opportunity to discuss the contribution of his father to his ethical upbringing, a topic of which Galen is very fond.Footnote 62

Galen’s moral enterprise was indebted to the Platonic and Aristotelian educational model, which maintained that human character was shaped by the right mixture of nature (physis) and training (askēsis).Footnote 63 Although in the passage we have just seen he presents both aspects as informing his own education (also Ind. 14, 82.1-2 PX), in referring to his father he makes clear that he was a man naturally endowed with qualities of character without having been exposed to the influence of philosophers (Ind. 13, 80.8-82.3 PX). Galen’s position on physis is a complex one, because he uses it with semantic flexibility across a variety of texts. For instance, in his Character Traits he talks about features of character that appear in infants as soon as they are born, and, correspondingly, states that anger and revenge are inherited, not learned, traits in man.Footnote 64 Physis seems somewhat less important in the Exhortation to the Study of Medicine (see Chapter 5) and more especially in Affections and Errors of the Soul, where nature together with early education and the application of reason represent the educational triad that made Galen immune to distress,Footnote 65 whereas in Doctrines of Hippocrates and Plato training trumps nature.Footnote 66 In Avoiding Distress, the triad excludes physis altogether and replaces it with rational arguments instead (Ind. 1, 54.1-2 PX). The reshaping of the same notion is to be explained in the light of each disquisition and its purpose(s) in each case.

To be more specific, Galen devotes a separate section of the Affections and Errors of the Soul to narrating the case of a young man in his close circle, who was surprised that Galen was not vulnerable to great disasters, whilst he himself was distraught even at trivial ones. When he sought an explanation for this, Galen told him that ‘nature has great power in childhood, so too does emulation of those amongst whom one lives, then at a later stage the important factors are doctrines and training’ (Aff. Pegg. Dig. 7, 25.21-24 DB = V.37.12-14 K.).Footnote 67 Textual evidence suggests that this essay is indeed addressed to a young man whose philosophical education is still at an elementary level, as will be argued in more detail in Chapter 6. For instance, he needs a moral supervisor to criticise his conduct (Aff. Pegg. Dig. 10, 36.16-17 DB = V.55.4-6 K.)Footnote 68 and there is an emphasis on the moral failings to which young people were especially attracted (Aff. Pegg. Dig. 26, 12-14 DB = 38.11-15 K.),Footnote 69 both ideas absent from Avoiding Distress. Therefore, the omission of physis as a determinant of psychic harmony at the beginning of Avoiding Distress is well adapted to the advanced philosophical stage of his addressee, who was expected to be indifferent to something that would affect someone in the initial stages of their training. On the other hand, the focus on the untutored nature of Galen’s father would have no place in an essay meant to teach young men the prime importance of correct training. The insertion of physis in the context of Avoiding Distress reflects Galen’s philosophical perceptiveness, because it is characteristic of Platonic-Aristotelian educational thinking on ethical development from which he drew inspiration, but not the Stoic approach, according to which early influences and instruction alone shape one’s moral character.Footnote 70 It is obvious that Galen’s eclectic subscription to different philosophical schools serves the aims of his practical ethics. That puts him in the same camp as Plutarch, who also opted for philosophical eclecticismFootnote 71 in the context of his moral project, rather than devoting himself to strict adherence to one philosophical ideology, as Epictetus, Seneca or Musonius Rufus had done.

A further caveat should be given about the relationship between Galen and his father. In Galen’s case his father’s role in the formation of his character is not exploited in the text as a philosophical topos, as in the writings of many other ancient thinkers.Footnote 72 Rather, it is an issue informed again by the practical experience he had gained from his own social reality, as can be seen, for example, from his allusion to the great contrast between the evil son Commodus and his philosopher father Marcus Aurelius, a relationship he had witnessed at first hand.Footnote 73

Galen’s way of treating the issue of the therapy of distress in the two accounts casts fresh light on his credentials as a moral writer, so I want to spend a while comparing them. ‘Galen’ describes how his father’s indifference to worldly pleasures (Ind. 14, 82.3-18 PX) set an example that led him to scorn fame, wealth and social standing (Ind. 15, 82.1-3 PX). In the Affections and Errors of the Soul Galen’s father is again depicted as a model for him by means of a polarised opposition between him and Galen’s wicked mother.Footnote 74 It is interesting, however, that in the Affections and Errors of the Soul Galen’s father is shown teaching him, among other things, the avoidance of distress, though Galen refrains from mentioning this in the corresponding part of the Avoiding Distress, where it would have fitted in well:

I had always recalled the counsel that my father gave me: that one should not be distressed by any material loss provided that what remains is adequate for the care of one’s body. This he laid down as the primary aim of possessions: to keep one from hunger, cold or thirst. If one happens to have more than is necessary for these purposes, one should, he believed, use it for good works. I have, indeed, up to now had access to sufficient resources to bestow in this way, too.Footnote 75

Aff. Pecc. Dig. 8, 30.10-16 DB = V.44.10-45.1 K.

The results of the training received from his father during his formative years as described in the Affections and Errors of the Soul have been internalised by Galen and he now passes it on as a mature philosophical authority in his Avoiding Distress. The link between the two essays testifies to Galen’s consistent train of moral thought; and the variations he makes, according to the requirements of each text, indicate the creativity with which he remodels the impact of emotions. In his proem to the second part of the Therapeutic Method, a technical work addressed to an experienced doctor, one Eugenianus, Galen admits that he had been distressed for a long time, so that he had been unable to touch a book.Footnote 76 Although this remark is at odds with his suggested calmness in his ethical works, it is noteworthy that Galen makes no claims to being an exemplum of moral reflection in the Therapeutic Method. His distress in the prefatory passage to the second part of this work could be a rhetorical explanation for the twenty-year gap between the composition of the first section of the work (Books 1–6) and the second (Books 7–14).

The reference to Galen’s repeated recollection (μεμνημένον) of his father’s counsel at the start of the passage above also merits attention for its salience in the process of moral pedagogy. Just as in the Affections and Errors of the Soul, in Avoiding Distress too Galen emphasises how remembering his father’s image makes him feel his soul is the better for it (ἀναμιμνῃσκόμενος ἑκάστοτε, βελτίων ἐμαυτοῦ τὴν ψυχὴν αἰσθάνομαι γινόμενος, Ind. 13, 80.6-7 PX). The notion of recollection (ἀνάμνησις) is critical in Imperial-period moral philosophical works.Footnote 77 In a passage in his Table Talk Plutarch appropriated the Platonic notion of recollection when he states that remembering (ἀναμνήσεις) very often has the same effect as learning does.Footnote 78 Galen is writing in the same spirit when he says elsewhere that recollecting people with moral vices makes one a complete entity,Footnote 79 generating moral progress. Moral anamnesis in Galen is therefore much more important to his apparatus of ethical modification than Ricardo Julião seems to have allowed.Footnote 80 On another level however, one wonders whether Galen’s focus on the concept of remembering may also have medical origins or links, rather than purely philosophical ones, given that in his Matters of Health remembering is part and parcel of successful bodily therapy as it is elsewhere, requiring the physician to recall every single day the diagnosis he had given on the previous day.Footnote 81 The recurrence of cognates of anamnesis in this context helps Galen make the point that the act of remembering the patient’s somatic condition will expose the fault in his body and determine the appropriate treatment.Footnote 82

Philosophical refutation through personal experience

In the last part of the treatise, Galen gets involved in philosophical debates regarding distress and more specifically the definition of apatheia. This passage helps us see how he understands this philosophical concept and makes us aware of the way he deploys it with syncretic flexibility. Although there are instances where Galen is a proponent of the Aristotelian belief in the moderation of emotions, known as metriopatheia,Footnote 83 there are other instances, for instance in his Affections and Errors of the Soul, where he seems to advocate complete freedom from affection (apatheia).Footnote 84 In Avoiding Distress he rejects Stoic apatheia, as he is keen to make clear that he has never seen anyone so wise as to be completely free from affections (Ind. 16, 84.5-6 PX). Here the allusion is to the Stoic sage, a paradigm of emotional imperviousness, with whom Galen does not want to be identified. Thus, the apatheia he has claimed to exercise throughout the essay has its limits:

For I disregard the loss of belongings as long as I am not deprived of everything and banished to a desert island; and [I disregard] bodily pain as long as I am not required to promise that I disregard the bull of Phalaris.Footnote 85

Ind. 16, 84.7-86.9 PX

The bull of Phalaris, a symbol of extreme physical torture in antiquity, is an allusion to the commonly held thesis among Epicureans and Stoics whereby the sage, in light of his ataraxia and claims to detachment, taught that life was pleasant even amidst sufferings.Footnote 86 Scholars have been perplexed by Galen’s unclear attitude towards apatheia and metriopatheia,Footnote 87 but at least in Avoiding Distress Galen seems to support a modified version of apatheia, freedom not from all emotions but from violent and disruptive ones.

The regulated apatheia he professes on a philosophical level also squares with Galen’s self-portrait as an ethical archetype. His admission that the destruction of his homeland or a friend’s punishment by a tyrant could cause him distress (λυπήσει δέ με, Ind. 16, 86.9 PX) shows that he now wants to be seen as a model that could be emulated by his readers, since his previous superhuman self-composure would have been beyond the capacity of normal people. So he goes on to pray to Zeus that no distressing event will ever happen to him, radically modifying the corresponding prayer of the Stoic Musonius Rufus, who used to ask Zeus to test him with any affliction. Likewise, he accepts his human weaknesses and acknowledges the unexpected frustration that he might feel as a result of changes to his physical and psychic state. Galen’s counsel against distress is here invested with his practical experience, because he never claims to be able to do what he had not shown himself capable of in practice (Ind. 16, 88.34-36 PX). His experience in this instance is a vehicle of persuasion.

Galen’s ethical optimism is also seen in the final address to his correspondent, which places the latter alongside Galen in terms of nature and education (Ind. 16, 88.41 PX) – a sign of merit. By the end of the text two categories of people have been established, the first represented by Galen’s addressee who prefers simple food and dressing and is sexually restrained, the second group including all those people who are slaves to sexual desires and can never satisfy their longing for money (Ind. 17, 90.2-8 PX). Galen’s ethics feeds into the realities of present-day life, since it acknowledges the tendency to aspire to social and political prestige that drives the elite. Here he connects patterns of behaviour to different types of people and reinvigorates assimilation and distancing strategies,Footnote 88 similar to those explored in Chapters 13. Thus, those people who are only moderately attached to esteem, wealth, reputation and political power are less likely to be afflicted by distress; people whose desires for public reputation are insatiable will lead miserable lives, unaware of the virtue of the soul and suffering grinding distress (Ind. 17, 90.9-15 PX).Footnote 89 In assessing the two groups, Galen attempts to shape his audience’s moral discernment and related decision-making. Critical to that process was also the way Galen showed his readers what would be the more socially acceptable course of action of the two presented to them, thus playing on their sense of social esteem, a pivotal quality of Graeco-Roman aristocracy. So by proposing a particular lifestyle, which Galen hopes the reader will follow, Avoiding Distress effectively shares features of the genre of advice literature (as distinct from that of therapeutic literature, according to the ancient classification).

The two kinds of moral attitude that Galen describes above do not stem from theory but from experience, which Galen now calls ‘a teacher of the unexpected’ (᾽Aλλ᾽ἡ πεῖρα καὶ τῶν ἀπροσδοκήτων διδάσκαλος γίνεται, Ind. 18, 90.1 PX). Elizabeth Asmis has hypothesised that Galen’s reflections in his Avoiding Distress encapsulate a ‘personal’ kind of philosophy, ‘which is integrated with one’s life’.Footnote 90 This has been construed in the light of Galen’s attachment to truth within the essay, but I think that his life experiences as well as his professional experience help bolster the notion of integration that Asmis sees in Galen’s personal philosophy. The quote above shows that, in Galenic ethics, experience functions strategically as a means of premeditation and a guarantor of success, as it is indeed in technical contexts, for instance in his The Capacities of FoodstuffsFootnote 91 or in his pharmacological essays The Composition of Drugs According to Kind and The Composition of Drugs According to Places.Footnote 92 At the same time, it is also a philosophical motivation for the composition of moral works. At the end of Avoiding Distress Galen’s daily experience with ordinary men stimulates him to reflect on the topic of love of wealth (φιλοπλουτία) – a traditional part of the remit of practical ethics – and write a separate treatise on that, which he also sends to his penfriend (Ind. 18, 92.5-7 PX).


In this Chapter, I have explored Galen’s characteristics as an ethical philosopher in the light of his newly discovered work Avoiding Distress. I have shown that his personal reflections on the issue of anxiety related to a particular event from his life help him build a strong ethical voice. And that by reliving his experiences as the victim of the calamity, he offers a precedent of actualised behaviour that can be actualised again, convincing the reader that he has firm knowledge of how to dispel anxiety in similar cases. That Galen’s correspondent is not a mere literary construction but an active associate in the process of reading points to the intimate character of Galen’s ethics and, on another level, helps make his psychological therapy more effective. The exposition of Galen’s losses is revealed gradually and is permeated with his manipulative asides, which suggest to his addressee and secondary audience considerations and emotions that retrospectively revive the feeling of distress until they ultimately free themselves from it. On many occasions, Galen’s applied ethics dovetail with his self-depiction as a practising physician, especially as regards the construction of his authority, the credibility of his account, the importance of personal experience, the issue of the amazement aroused by his performances, and the salience of anamnesis in the process of moral therapy and progress. All these individual features are hardly likely to have occurred in other, now lost, essays peri alypias, although this assumption must remain a speculative one.

In his Avoiding Distress, Galen resorts to moralising devices of considerable sophistication by combining philosophical remedies from different schools of thought. The rich Stoic background mixed with material from the Platonic and Aristotelian tradition situate Galen firmly within the genre of the therapy of emotions. But at the same time this mix shows that what matters mostly for him is the moralising impact of the philosophical material he is using, even if this means drawing material from schools he was not generally in favour of. His statement towards the end of Avoiding Distress that he neither wrote this essay with zealous enthusiasm nor considering it an important task, but simply as a sort of pastime (Ind. 15, 84.8-9 PX) is more likely a trope of self-effacement. The dynamics of Galen’s ethics not only in Avoiding Distress but also as it evolved in Affections and Errors of the Soul and elsewhere, expressed in the subtle retexturing of his ethical instruction according to the philosophical level of his addressee and the needs of the argumentation in each case, demonstrates that this statement is not to be trusted.

But the best judge of success is always the audience and, at least as far as Avoiding Distress is concerned, its programme of psychological therapy has proved to have benefited not only contemporary readers. The Vlatadon manuscript preserves a number of scholiastic lines of Byzantine verse acknowledging Galen’s ethical precepts:

Thanks be to you, Galen, for your advice, in which you teach all mortals to bear the uncertainties of life without distress, and not be disturbed at all by the losses; … In repeated misfortune, you are a clear beacon in your life.Footnote 93

This testimony to the Byzantine reception of the text encapsulates the main point I have made here, that the author’s life experiences profoundly inform the suggested cure for distress. Most significantly, it acknowledges Galen’s contribution as a moral philosopher whose intellectual ambitions embrace the therapy of the emotions across a broad social spectrum.


1 A fifteenth-century manuscript from Constantinople, discovered in the Vlatadon monastery in Thessaloniki. Avoiding Distress covers fol. 10v–14v. For a description of the Vlatadon 14, see Pietrobelli (Reference Pietrobelli2010) and Polemis and Xenophontos (2023: 27).

2 Avoiding Distress is mentioned in a ninth-century catalogue of Galen’s works provided by Ḥunayn ibn ʾIsḥāq in his Epistle (Risālah); see Bergsträsser (Reference Bergsträsser1925: 40) no. 120 = Lamoreaux (Reference Lamoreaux2016: 122) §130. We know that it was translated into both Syriac and Arabic, although none of the translations survive today. In the late twelfth and early thirteenth centuries, Joseph Ibn ʿAqnīn, student of Maimonides, quoted many passages from Avoiding Distress in his Arabic Hygiene of the Soul; see Halkin (Reference Halkin1944: 60–147). Afterwards it was cited by other Arabic and Hebrew authors of the thirteenth century; see Zonta (Reference Zonta1995: 113–123) and Boudon-Millot, Jouanna and Pietrobelli Reference Boudon-Millot, Jouanna and Pietrobelli2010b: LXX-LXXIV for additional information.

3 Lib. Prop. 15, 169.13 Boudon-Millot = XIX.45.10-11 K.

4 I translate lypē in its broadest sense ‘distress’, which is close to modern psychiatric definitions of ‘anxiety’, hence my occasional use of that term.

5 πειρᾶσθαι δὲ καὶ τὸ ἐναντίον ἀντεισάγειν ἀεὶ τῷ λυπήσαντι … τὴν ἐν λόγοις τε καὶ πράξεσι καὶ θεάμασι καὶ διηγήμασι θυμηδίαν. These psychotherapeutic activities resemble the ones Celsus proposed for mentally disturbed patients, De Med. 3.18.11-12 (124.17-125.2 M.), and those described by Anonymous Parisinus in 19.3.7-10 (118.27-120.9 Garofalo).

6 This is the Hippocratic principle ‘opposites are cured by opposites’ (contraria contrariis curantur).

7 The redirection of the mind, either visually or aurally, is also referred to by Galen in his On Problematical Movements, a work on anatomy in which Galen also speaks as physician. The case concerns an otherwise exemplary practitioner of philosophy (he was immune to servility and envy as well as a lover of truth in words and deeds), who took some time, however, to realise the importance of distraction in minimising bodily pain, Mot. Dub. 8.24-29, 160.4-20 Nutton. On distraction in general, see Nutton (Reference Nutton2020: 121–123).

9 Rothschild (Reference Rothschild, Rothschild and Thompson2014) explores the political dimension of Avoiding Distress, discussing passages that ‘convey obliquely disapproving political commentary’ and ‘express political disdain while avoiding direct confrontation and punishment’ (p. 179).

11 The recent volume edited by Petit contains a number of such studies: e.g. Petit (Reference Petit and Petit2019: 51–61), Gill (Reference Gill and Petit2019), Hankinson (Reference Hankinson and Petit2019b), Singer (Reference Singer and Petit2019b), Tieleman (Reference Tieleman and Petit2019). See also Kaufman (Reference Kaufman2014) and Kotzia (Reference Kotzia, Rothschild and Thompson2014). A partial exception is perhaps Rosen (Reference Rosen, Rothschild and Thompson2014).

12 Eratosthenes of Cyrene (third century BC), Diogenes of Babylon (second century BC) and Plutarch (‘The catalogue of Lamprias’ no. 172) were all said to have written a lost essay entitled Περὶ ἀλυπίας. There is also a work by John Climacus of the seventh century AD, with the title Περὶ ἀπροσπαθείας, ἤγουν ἀλυπίας (On Tranquillity of the Soul, or Rather on Avoiding Distress, Book 2 from his The Heavenly Ladder), an interesting example of how Stoic moral notions were appropriated into Christian ethics.

13 On the convention of writing at the request of friends and its rhetorical potential, see König (Reference König, Gill, Whitmarsh and Wilkins2009: 40–58); on letter writing as therapy for the soul in Galen, see Boudon-Millot (Reference Boudon-Millot, Laurence and Guillaumont2010a: 128–132); on the form and function of the Greek letter-essay, see Stirewalt (Reference Stirewalt and Donfried1991).

14 Unlike Galen’s brief references to the fire of 192 AD in On My Own Books and On Antidotes, the same event is described at quite some length in The Composition of Drugs According to Kind (Comp. Med. Gen. 1.1, XIII.362.1-363.1 K.). Here the author mentions the losses in an impersonal report, shying away from including the emotional effects of the disaster in his account. The same event is also reported by the historians Cassius Dio (Roman History 72.24) and Herodian (Roman History 1.14.2-6), again in the form of a factual reportage.

15 On the date of the essay’s composition, see Boudon-Millot (Reference Boudon-Millot2007: 76), Boudon-Millot, Jouanna and Pietrobelli Reference Boudon-Millot, Jouanna and Pietrobelli2010b: LVIII-LIX, and Nutton (Reference Nutton2013: 45–48).

17 Stobaeus, Anthology 2.7.2; cf. 2.39.20-41.25. See Brittain (Reference Brittain2001: 277–280) and Gill (Reference Gill and Inwood2003: 42–43). The genre of therapy of emotions pre-dates Philo and goes back at least to Chrysippus’s ‘therapeutic’ Book 4 of his On Passions; on this point, see Gill (Reference Gill2010: 280–300) and Tieleman (Reference Tieleman2003a: 140–197).

18 Mainly Boudon-Millot (Reference Boudon-Millot2007: 75–76), who later reconsidered the generic identity of the essay, in Boudon-Millot, Jouanna and Pietrobelli Reference Boudon-Millot, Jouanna and Pietrobelli2010b: x. See also Rosen (Reference Rosen, Rothschild and Thompson2014: 160, Footnote n. 4) and Rothschild and Thompson (Reference Rothschild, Rothschild and Thompson2014: 14). Traditional consolations include Cicero’s Consolation on the death of his daughter Tullia, Seneca’s Consolation to Marcia or Consolation to Polybius, Plutarch’s Consolation to his Wife and pseudo-Plutarch’s Consolation to Apollonius.

19 See Boudon-Millot (Reference Boudon-Millot and Gilliers2008a: 9) and Levy (Reference Levy2011: 204–205). Kaufman is right to place Avoiding Distress in the broader group of works that have been called ‘metaconsolatory’, which in essence overlap with popularised works on practical ethics; see Kaufman (Reference Kaufman2014: 275, with Footnote n. 2). Cf. Gill (Reference Gill and Harris2013: 341). For the distinction between the categories of works on alypia and paramythia, see Epictetus, Discourses 3.24.116.

20 In that sense, autobiography in Galen has a strong moral purpose, as argued in the course of this study, and not just an epistemological function, as posited by Boudon-Millot (Reference Boudon-Millot, Gill, Whitmarsh and Wilkins2009: 188).

21 There are various structural outlines of the treatise; see e.g. White (Reference White, Rothschild and Thompson2014: 223), Xenophontos (Reference Xenophontos2014: 589) or Jones (Reference Jones2009: 390).

22 Gill (Reference Gill and Harris2013: 352–354). The other three features being ‘the conception of happiness involved’, ‘the psychological framework assumed’ and ‘advice about how to carry the therapeutic process forward’, Gill (Reference Gill and Harris2013: 348–351). On the work’s generic identification as a letter-treatise, see e.g. Rothschild and Thompson (Reference Rothschild, Rothschild and Thompson2014: 13).

23 For the eyewitnesses’ role in cementing the credibility of Galen’s accounts, see Lehoux (Reference Lehoux, König and Woolf2017).

24 Langlands (Reference Langlands2018: 94).

25 Galen seems to accept that there are gradations of lypē in different people and to draw a distinction between retrospective and prospective distress, the former for events that have already taken place (e.g. the death of someone close), the latter for events that might happen in the future (e.g. political unrest), Hipp. Progn. 1.4, 207.5-20 Heeg = XVIIIB.19.1-12 K.

26 The phenomenology of lypē (how the passion is experienced) is telling here, since Galen’s description includes the participle συντακείς (literally ‘he melted away’) as an apt correlate to the fire. LSJ s.v. συντήκω A.II.2, with Plato, Timaeus 83b; also in Comp. Med. Gen. 2.1, XIII.459.4-5 K. Galen’s choice of the term συντακείς in Avoiding Distress is also in line with the naturalistic effects of lypē as explained in his medical accounts. Σύντηξις (colliquescence) refers to loss of weight due to lypē in Prolaps. 1.29, XVIIIA.362.11-364.2 K. On the experience of grief in Galen, see King (Reference King, Chaniotis and Ducrey2013) and Mattern (Reference Mattern, Petridou and Thumiger2016).

27 The name of the grammarian is dubious. Vlatadon reads Philides, BM corrected to Philippides, Nutton in his English translation of the work in Singer (Reference Singer2013: 79) suggested Philistides, whereas Kotzia emended to Kallistos, following Pfaff’s reconstruction of the name from the Arabic in a close parallel in Galen’s Commentary on Hippocrates’s ‘Epidemics VI’, 486.19-24 WP. None of these names can be supported by the secondary tradition. In PX we have therefore adopted the reading of the manuscript.

28 Fitzgerald (Reference Fitzgerald, Rothschild and Thompson2014) explores the physiognomic aspects of Galen’s cheerful disposition in Avoiding Distress.

29 See Thras. 1, 33.1-7 Helmreich = V.806.4-9 K. οn Galen’s similar closeness to his addressee. On the role of friendship in philosophical spiritual guidance, see Hadot (Reference Hadot and Armstrong1986: 449–450).

30 Foucault (Reference Foucault1990b: 53).

31 Mainly Mattern (Reference Mattern2008a), García Ballester (Reference García Ballester1995); cf. Álvarez-Millán (Reference Álvarez-Millán1999: 30–33).

32 On thaumazein in case histories in relation to praise, see Mattern (Reference Mattern2008a: 80–83). On the performative aspect of Galen’s anatomical demonstrations, see Gleason (Reference Gleason, Gill, Whitmarsh and Wilkins2009: 85–114); cf. Debru (Reference Debru and van der Eijk1995).

33 Praen. 2, 80.22-25 N. = XIV.612.9-12 K.

34 Praen. 11, 126.26-128.32 N. = XIV.657.12-660.16 K.

35 Praen. 2, 74.15 N. = XIV.605.17 K.

36 On the notion of ‘communality’ in Galen, see König (Reference König, Klotz and Oikonomopoulou2011: 183–186). The term ‘sociative’ was coined by Slotty (Reference Slotty1928). See Asper (Reference Asper and Fögen2005) for Galen’s use of other grammatical constructions (e.g. the integratives Wir or the anthropologisches Wir) and rhetorical devices, such as the Appellstruktur designed to build a rapport with his reader and establish his authority. Cf. Mattern (Reference Mattern2008a: 138–140).

37 The same can be said to some extent of Seneca, on which see Bertsch (Reference Bertsch, Bartsch and Schiesaro2015) and Edwards (Reference Edwards1997).

38 On hypomnēmata in Plutarch, see Xenophontos (Reference /Xenophontos2012) with additional references. On Galen’s hypomnēmata, see Pietrobelli (Reference Pietrobelli, Delattre, Valette, Cottier, Kefallonitis, Ribreau and Soler2018: 85–92).

39 Hine (Reference Hine, König and Woolf2017) explores the issue of philosophical authority in Seneca.

40 Long (Reference Long2002: 43–44), though of course this is often lost in the summaries in the Manual (Encheiridion). See also Long (Reference Long2002: 52–66) on Epictetus’s styles of discourse.

41 Nussbaum (Reference Nussbaum, Schofield and Striker1986); cf. Mitsis (Reference Mitsis1993) with reference to didactic coercion in Lucretius.

42 On how suggestions can influence our cognition and behaviour, see the study by Michael, Garry and Kirsch (Reference Michael, Garry and Kirsch2012) with additional references; also Caner (Reference Caner1954). On the practical application of suggestion in the medical sphere, including constructed statements that promote suggestion, see Bernheim (1888, repr. Reference Bernheim1985), Sidis (Reference Sidis1973). Rosen (Reference Rosen, Rothschild and Thompson2014: 165) has construed Galen’s strategy in the light of modern transference theory.

43 Οὔτε οὖν ὅσα σπάνια καὶ ἀλλαχόθι μηδαμόθεν κείμενα δυνατόν ἐστιν εὑρεῖν [ἐστιν], οὔτε τῶν μέσων, διὰ δὲ τὴν τῆς γραφῆς ἀκρίβειαν ἐσπουδασμένων, Καλλίνεια καὶ Ἀττίκεια [μέν] καὶ Πεδουκίνεια, καὶ μὴν Ἀριστάρχεια, οὗτινός εἰσιν Ὅμηροι δύο, καὶ Πλάτων ὁ Παναιτίου καὶ ἄλλα πολλὰ τοιαῦτα … Καὶ γὰρ γραμματικῶν πολλῶν αὐτόγραφα βιβλία τῶν παλαιῶν ἔκειντο καὶ ῥητόρων καὶ ἰατρῶν καὶ φιλοσόφων. Square brackets indicate deletions by the editors, whereas angle brackets enclose letters or words added by the editors.

44 Τί ποτε οὖν, φήσεις, ἔτι μεῖζον ἁπάντων τῶν εἰρημένων ἐστίν, ὃ λυπεῖν <ἂν> δύναιτο; Καὶ δή σοι φράσω τοῦτο.

45 A frequent course of action in Galen. Remember Comp. Med. Loc. XIII. 8.1, 116.1-117.5 K. discussed in Chapter 1. See also the preface of Affections and Errors of the Soul analysed at the start of Chapter 6.

46 Also in Galen’s Protr. 5, 90 B. = I.8-9 K.

47 πάνυ καλῶς ἐνδεικνύμενος ὃ πολλάκις ἤκουσας παρ’ ἐμοῦ λεγόμενον, ὡς οὐ χρὴ πρός τι τῶν ἀπολλυμένων ἐμβλέπειν ἀλλὰ λογίζεσθαι πῶς οἱ τρεῖς ἀγροὺς δεξάμενοι τοῦ πατρὸς [οὐκ ἀνέξοντo] βλέπειν οὐκ ἀνέξονται ἑτέρους ἔχοντας τριάκοντα.

48 For example, Wood, Joseph and Linley (Reference Wood, Joseph and Linley2007).

50 For Plato and Aristotle, ‘noble’ as a contrast to ‘malicious’ was one of the criteria for approving or disapproving of an ethical action: Republic 363e-364a, Nicomachean Ethics 1104b32.

51 Also in Plutarch’s On How to Benefit from your Enemies 87A, On the Tranquillity of the Soul 467C-D and On Exile 603D, in Seneca’s On Tranquillity of the Soul and in Diogenes Laertius’ Lives of the Philosophers 7.5.

52 Ind. 11, 76.1 PX and Ind. 11, 76.11-12 PX.

53 Brennan (Reference Brennan and Inwood2003: 269–274).

54 See Cicero’s formulation of rerum externarum despicientia attributed to Panaetius in On Duties 1.66.

55 The term “diatribe” is nowadays conventionally used to refer to a rhetorical form of moral teaching and exhortation, although it does not designate anything that was recognised in antiquity as a distinct form or kind. Instead, the word διατριβή in ancient literature was used to denote either a lecture or an account of a philosopher’s informal interactions with his students. I am grateful to Michael Trapp for this clarification. See also Fuentes González (Reference Fuentes González1998: 44–55).

56 Galen’s phrase ‘I knew nothing of these things on my first stay in Rome’ with reference to rivalries and vices in Praen. 2, 74.12-13 N. = XIV.605.13-15 K. suggests that he considered Pergamum a morally superior place. On the corruption of the medical profession, see for instance, Opt. Med. Cogn. 1, 41.1-47.14 I. with Chapter 7.

57 Seminal discussions include: Anderson (Reference Anderson1993), Swain (Reference Swain1996), Goldhill (Reference Goldhill2001), Whitmarsh (Reference Whitmarsh2001). On Galen’s complex relation to the Second Sophistic, see von Staden (Reference von Staden and Sorabji1997b). On the contrast between Rome and Pergamum in Galen, see Boudon-Millot (Reference Boudon-Millot2008b: 71–74).

58 See Gill (Reference Gill2007), who advances the interesting argument that Galen’s polemic against a thesis or doctrinal group does not amount to a strong opposition to it, but rather acts as an ‘intellectual foil’ that enables him to define his own approach. Gill also stresses that Galen’s demarcation of intellectual friends and enemies is fuzzy in so far as he ‘constructs shifting patterns of intellectual alliance and hostility according to the specific thesis maintained in each treatise’, Gill (Reference Gill2007: 92). Cf. Levy (Reference Levy2011).

59 See, for instance, Armisen-Marchetti (Reference Armisen-Marchetti and Fitch2008). Studies on the techniques of ancient meditation include Rabbow (Reference Rabbow1954), Hadot (Reference Hadot1969) and Hadot (Reference Hadot1981). On the history of meditation in Imperial-period Stoicism, see Newman (Reference Newman1989). For a brief history of psychotherapy in antiquity, see White, McGeachan, Miller and Xenophontos (Reference White, McGeachan, Miller and Xenophontos2020: 730–733).

60 Marcus Aurelius, Meditations 7.33 and 7.64 respectively.

61 In an unknown Euripidean play (fragm. 964; Kannicht, TrGF vol. 5, p. 963); Theseus is the speaker: ‘as I once learned from a wise man, | I fell to considering disasters constantly, | imagining for myself exile from my native land, | and untimely deaths and many other misfortunes, | so that if I ever suffer anything of what I was imagining | it will not be unexpected and will not tear my soul apart’. Cf. Galen, PHP 4.7, 282.17-23 DL = V.418.8-13 K.

62 For example, in his MM 8.3, X.560-561 K.

63 On physis in Galen, see Jouanna (Reference Jouanna and Jouanna2003) and Kovačič (Reference Kovačič2001); on physis in Galen’s psychology in particular, see Kovačič (Reference Kovačič2001: 151–194).

64 De Mor. 29 Kr.

65 Aff. Pecc. Dig. 7, 25.20-21 DB = V.37.10-11 K. See also Gill (Reference Gill and Harris2013: 355).

66 PHP 9.2, 550.8-31 DL = V.732.13-734.10 K.

67 καὶ γὰρ καὶ τὴν φύσιν ἐν ἅπασιν ἔφην [εἰ] δύνασθαι μέγα ἐν τῇ τῶν παιδίων ἡλικίᾳ <καὶ τὴν> τοῖς συζῶσιν ὁμοίωσιν, εἶθ’ ὕστερον τά τε δόγματα καὶ τὴν ἄσκησιν.

68 Note that in his medical work The Best Method of Teaching Galen once again recommends the presence of a teacher supervisor, whose aim is to correct the mistakes that arise from the natural deficiencies of the young student.

69 In the Affections and Errors of the Soul Galen discusses another cause of distress beside material losses, i.e. the one that comes from a sense of shame, a feeling to which young people are especially prone. Again Galen plays with the social expectations of his addressees, as Graeco-Roman society was predominantly a society of aidōs.

70 An opinion developed by Cleanthes (Stobaeus, Eclogues 2.65.8-9), probably in his On Excellence of Natural Endowment (Diogenes Laertius, Lives of the Philosophers 7.175) and by Chrysippus (Plutarch, On Common Notions Against the Stoics 1069E).

72 The Stoics, for instance, held that the relationship between the parent and the child was ‘a central paradigm of human sociability and of the desire to express virtue in action’, Gill (Reference Gill and Inwood2003: 46).

73 Cf. Zonta (Reference Zonta1995: 48–49), fragm. 15–16.

74 Aff. Pecc. Dig. 8, 27.22-28.8 DB = V.40.15-41.9 K. More on that in Chapter 6.

75 μεμνημένον ὧν ὁ πατὴρ ὑπέθετο, μὴ πρότερον ἐπὶ χρημάτων ἀπωλείᾳ λυπηθῆναι συμβουλεύων, ἄχρις <μὴ> ἂν ᾖ τὰ λειπόμενα πρὸς τὴν τοῦ σώματος ἐπιμέλειαν αὐτάρκη. τοῦτον γὰρ ἐτίθετο πρῶτον ὅρον ἐκεῖνος κτημάτων, ὡς μὴ πεινῆν, μὴ ῥιγοῦν, μὴ διψῆν. εἰ δὲ πλείω τῆς εἰς ταῦτα χρείας εἴη, καὶ πρὸς τὰς καλὰς πράξεις, ἔφη, χρηστέον αὐτοῖς. ἐμοὶ τοίνυν ἄχρι δεῦρο τοσαύτη χρημάτων κτῆσίς ἐστιν, ὡς καὶ πρὸς τὰς τοιαύτας πράξεις ἐξαρκεῖν.

76 Galen, MM 7.1, X.457.8-10 K.

77 The notion figures prominently above all in Plato, where it has a more theoretical baggage. It denotes the retrieval of knowledge subconsciously familiar to the individual, which needs to be shaped through Socratic dialectics in order to engender philosophical truth and virtue; e.g. Plato, Meno 81c-85d.

78 Plutarch, Quaest. Conv. 629E; cf. 686D.

79 Aff. Pecc. Dig. 5, 18.4-5 DB = V.25.8-10 K.

81 One of a doctor’s professional virtues is to have a good memory, Ord. Lib. Prop. 4, 99.18-19 Boudon-Millot = XIX.59.2 K.

82 San. Tu. 5.2, 138.6-140.34 Ko. = VI.312.10-318.16 K., including the following passage: ‘It is the recollection of what previously existed (ἡ μνήμη δὲ τῶν προγεγονότων) that will show you the fault (τὸ ἁμαρτηθὲν ἐνδείξεταί σοι) and will teach the correction through the comparison with what presently exists (διδάξει τὴν ἐπανόρθωσιν ἐκ τοῦ παραβάλλεσθαι τοῖς ἐνεστῶσιν).’

83 Hankinson (Reference Hankinson and Petit2019b: 173–175).

85 Χρημάτων μὲν γὰρ ἀπωλείας καταφρονῶ μέχρι τοῦ μὴ πάντων ἀποστερηθεὶς εἰς νῆσον ἐρήμην πεμφθῆναι, πόνου δὲ σωματικοῦ μέχρι τοῦ μὴ καταφρονεῖν ἐπαγγέλλεσθαι τοῦ Φαλάριδος ταύρου.

86 Cicero, Tusculan Disputations 2.17-18, 5.31; Plutarch, That it is Impossible to Live a Pleasant Life According to Epicurus 1088B, 1090A. The same was the case with the Stoic sage, who was expected to have risen above the emotions of pain or anger, SVF 3.586.

88 van Hoof (Reference van Hoof2010: 160–161).

89 Cf. Protr. 4-5, 87-89 B. = I.5-7 K., on groups of people with whom Galen discourages identification.

91 Alim. Fac. 1.1, 5.23-6.3 Wilkins = VI.457.8-12 K.

92 van der Eijk (Reference van der Eijk and Debru1997a), Totelin (Reference Totelin2012). See also Sem. 1.2, 64.15-27 De Lacy = IV.513.7-514.6 K. In Galen’s technical texts, peira (contrasted to mere logos) is usually connected with his strategy of self-promotion and the construction of his authority, on which see e.g. Nutton (Reference Nutton, Taub and Doody2009b). See also, von Staden (Reference von Staden and Vázquez Buján1994). On the critical role of empirical research in Greek science, see Lloyd (Reference Lloyd1979).

93 Σοὶ μέν, Γαληνέ, τῶν λόγων ἔστω χάρις, | οἷσπερ διδάσκεις τὸν παλίνδρομον βίον | βροτοὺς ἀλυπότατα σύμπαντας φέρειν | μηδὲ κλονεῖσθαι τοῖς ἀνυπάρκτοις ὅλως. … | αὐτὸς ἀλλεπαλλήλου Τύχης, | εἰκών τε σαφὴς ὑπάρχεις ἐν τῷ βίῳ, 92 PX.

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  • Avoiding Distress
  • Sophia Xenophontos, Aristotle University, Thessaloniki
  • Book: Medicine and Practical Ethics in Galen
  • Online publication: 14 December 2023
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  • Sophia Xenophontos, Aristotle University, Thessaloniki
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  • Avoiding Distress
  • Sophia Xenophontos, Aristotle University, Thessaloniki
  • Book: Medicine and Practical Ethics in Galen
  • Online publication: 14 December 2023
  • Chapter DOI:
Available formats