Vinaire's Blog

Reference: SC: Psychology

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Progressive Physicians

Asclepiades of Bithynia (124-40 BCE) represents one of history’s most progressive psychiatric reformers. Practicing in Rome, he rejected Hippocratic humoral theory, instead proposing that disease resulted from blockages in the movement of önkoi (imperceptible atomic particles) through theoretical pores in the body—including the brain. This proto-molecular medicine led him to fundamentally different therapeutic approaches.

Most revolutionary were Asclepiades’ humane treatment methods:

• Fresh air and natural light rather than darkness and dungeons
• Music therapy using soothing sounds to calm agitated patients
• Hydrotherapy with therapeutic baths
• Massage and exercise programs
• Proper diet to support recovery
• Pleasant environments conducive to healing

His therapeutic motto—“cito, tuto, jucunde” (safely, swiftly, pleasantly)—stood in stark contrast to the chains, whipping, bloodletting, and forced emetics commonly employed. Asclepiades advocated releasing mentally ill persons from confinement and treating them with dignity, recognizing that the mind could be healed through gentle, supportive interventions.

Celsus (1st century CE) provided the first systematic taxonomy of mental illnesses (genera insaniae) in his De Medicina. He distinguished three primary types:

1. Phrenitis: acute delirium accompanied by fever, fluctuating pulse rates, and spastic movements—likely organic delirium from physical illness
2. Mania: characterized by chaotic thoughts, frenzy, anger, and delusions occurring without fever—corresponding to what we would call acute psychosis or manic episodes
3. Melancholy: persistent sadness, fear, despair, and withdrawal from external reality into an “impenetrable inner world”—encompassing both depression and paranoid or catatonic states we might now associate with schizophrenia

Soranus of Ephesus (1st-2nd century CE), whose work was translated by Caelius Aurelianus, provided detailed clinical descriptions and developed sophisticated treatment protocols including restoration therapy after acute phases subsided.

Galen of Pergamon (129-216 CE) synthesized and expanded Greek medical knowledge, creating a comprehensive system that dominated Western medicine for 1,500 years. Galen:

• Emphasized the brain’s central role in mental functioning, developing a proto-neurological approach
• Described how imbalanced humors specifically affected brain operations
• Recognized anxiety disorders, noting patients with symptoms resembling generalized anxiety or major depression—sweating, indigestion, palpitations, dizziness, insomnia, weight loss
• Observed that anxiety could “develop into melancholia” when black bile accumulated in the brain, causing delirium, aggression, or suicidal behavior
• Described brain injuries and their cognitive consequences

Aretaeus of Cappadocia (2nd century CE) provided remarkably modern clinical descriptions, noting melancholic patients’ “aversion to food, despondency, sleeplessness, irritability, and restlessness”. His observations of aura, convulsions, and postictal states in epilepsy closely resemble modern clinical understanding.

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Treatment Modalities

Roman therapeutic approaches combined:

1. Environmental interventions: well-lit rooms, moderate temperatures, therapeutic gardens
2. Physical therapies: massage, exercise, hydrotherapy at Roman baths
3. Dietary regimens: carefully calibrated to restore humoral balance
4. Pharmacological treatments: various herbs and compounds
5. Bloodletting, emetics, and purging: to expel excess humors (though now recognized as harmful)
6. Asclepian temple healing: serene sanctuaries providing relaxation, proper diet, dream interpretation, and social support
7. Musical therapy: using soothing music therapeutically

Wealthy Roman families sometimes employed personal physicians specializing in mental conditions, providing individualized care in home settings.

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Persistent Popular Beliefs

Despite medical advances, popular Roman culture maintained traditional supernatural explanations. Cicero (106-43 BCE) distinguished between:

• Insania: a relatively mild condition caused by moral weakness or failure of will
• Furens: serious, total loss of mental reasoning making individuals unable to function—inflicted by the Furies (Erinyes), three bloodthirsty goddesses who drove mortals mad as divine punishment

The rise of Christianity saw a resurgence of demonic possession theories, temporarily eclipsing the naturalistic medical tradition.

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