Reference: SC: Psychology

From Greco-Roman Naturalism to Christian Supernaturalism

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Early Imperial Rome (1st-2nd Centuries):
Medical Systematization

The opening centuries of the Christian Era marked the culmination of Greco-Roman medical thought regarding mental disorders. 

Aulus Cornelius Celsus (c. 25 BCE-50 CE) produced the first systematic taxonomy of mental illnesses in his encyclopedic work De Medicina. His classification system represented a sophisticated attempt to categorize the diverse manifestations of psychological distress into distinct disease entities: phrenitis (delirium accompanied by fever), melancholia (depression), a disorder characterized by false images and disordered judgment (resembling modern schizophrenia), delirium arising from fear, lethargus (coma), and morbus comitialis (epilepsy). Celsus introduced the term insania (insanity) into medical vocabulary and advocated for a range of treatments that combined harsh interventions—bleeding, frightening the patient, emetics, total darkness—with more humane approaches such as music therapy, travel, sport, reading aloud, and massage.

Aretaeus of Cappadocia (active in the second half of the 2nd century CE) advanced clinical psychiatry through meticulous observation and detailed case documentation. His most significant contribution was recognizing the cyclical nature of certain mental conditions, observing that some patients alternated between periods of profound melancholia and states of mania—an early description of what contemporary psychiatry recognizes as bipolar disorder. Aretaeus differentiated nervous diseases from mental disorders and provided classic accounts of various forms of insanity, including hysteria, headaches, mania, and melancholia, describing patients as experiencing “aversion to food, despondency, sleeplessness, irritability, and restlessness”.

Galen of Pergamum (129-216 CE) synthesized and expanded upon Hippocratic humoral theory, asserting that mental disturbances resulted primarily from humoral imbalances in the brain that damaged its functioning. His therapeutic approach aimed at re-establishing the balance of bodily humors through evacuations, drugs, and dietary modifications. Galen’s most innovative contribution was his recognition of psychosomatic relationships—he famously documented a case in which a female patient’s pulse became irregular when the name of a specific male dancer was mentioned, leading him to conclude that the patient was “in love” and demonstrating that “thinking can lead to physiological consequences”. This observation represented “the first clear description of a psychosomatic (mind-body) relationship”. Galen emphasized the importance of counsel and education in treating psychological problems, recommending that therapy involve “a mature, unbiased older person” who would confront patients whose passions—anger, jealousy—were responsible for their psychological difficulties.

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The Christian Transformation (3rd-5th Centuries):
The Return of Supernatural Explanations

The rise of Christianity as the dominant religious and intellectual force in the Roman Empire precipitated a profound shift in explanations of mental illness. As Christianity spread, “ideas about sin dominated, and the ‘psychotherapists’ of the era were priests rather than physicians”. The Church became “the primary authority on health and illness, and religious interpretations replaced medical ones”. Mental disorders were increasingly viewed through the lens of demonology—the belief that demons or evil spirits could possess humans and cause abnormal behaviors. Church authorities often interpreted unusual behaviors, emotional disturbances, or psychological symptoms as evidence of demonic influence or punishment for sin. This represented a regression from the naturalistic explanations that had characterized Greco-Roman medicine.

Yet the picture was more complex than simple rejection of medical knowledge. 

Tertullian (c. 160-c. 220 CE), despite his theological rigor, “showed greater respect for physicians than many of his pagan contemporaries” and demonstrated extensive knowledge of contemporary medical thought. His anthropology emphasized “the indivisible unity of flesh and soul,” which paradoxically led him to maintain an “elevated view of the body” and appreciation for medical treatment. Early Christians generally “accepted Greco-Roman ideas that disease results from an imbalance of the humors and disconnect between mind and body”, attempting to remove excess humors through purgative medicines, bloodletting, and cauterization. Church fathers like Tertullian, Clement of Alexandria, and others “saw medicine as God’s gift”.

Origen (c. 184-c. 253 CE) developed a sophisticated theological psychology grounded in Platonic philosophy. His doctrine of the preexistence of souls posited that God originally created incorporeal “spiritual intelligences” (psychaí) devoted to contemplating their Creator. As the “fervor of the divine fire cooled,” these intelligences grew “bored of contemplating God” and their love “cooled off” (psýchesthai), transforming them into souls (psychē) encased in material bodies. For Origen, mental and spiritual conditions reflected the degree to which a soul had fallen from its original state of contemplation. He theorized that “a single lifetime is not enough for a soul to achieve salvation, for certain souls require more education or ‘healing’ than others”, prefiguring later concepts of spiritual development and therapeutic education. Origen’s framework integrated body and soul: “the purity and subtleness of the body with which a soul is enveloped depends upon the moral development and perfection of the soul to which it is joined”.

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Monastic Psychology (4th-5th Centuries):
The Desert Fathers and Acedia

The emergence of Christian monasticism in the deserts of Egypt, Syria, Palestine, and Mesopotamia between the 3rd and 7th centuries created a unique laboratory for psychological observation and spiritual therapy. The Desert Fathers, who sought lives of solitude, manual labor, contemplation, and silence, developed sophisticated understandings of mental and spiritual afflictions. These monks, who “we could also say were the first therapists,” created recommendations to heal the “sicknesses of the soul”.

Evagrius of Pontus (346-399 CE) produced Antirrhetikos, “the first and most complete early Christian book on demonology”. He systematized eight “wicked thoughts” (logismoi) that afflict Christians: gluttony (gastrimargia), sexual infidelity (porneia), greed (phylargia), pride (hyperephania), despair (lype), anger (orge), boasting (kenodoxia), and acedia (akedia). Acedia, “the most troublesome of all” the evil thoughts, was characterized by spiritual listlessness, torpor, restlessness, boredom, and indifference to religious practice. Evagrius associated acedia with “the plague that stalks at noonday” (Psalm 91:6), calling it “the noonday demon” that struck when monks were at their weakest—when the midday sun beat down, their energy waned, and their fasting stomachs growled. The afflicted monk experienced “an inert state without pain or care,” becoming “resistant to prayer and devotional reading,” unmoved by “rebuke or exhortation,” “spiritually numb and completely inert”.

John Cassian (360-435 CE), Evagrius’s student, transmitted these insights to Western monasticism through his Institutes and Conferences. Cassian’s vivid description of acedia’s manifestation in a monk’s cell captures its psychological reality: “He fancies that he is making no progress… he complains that he is unfruitful… he looks anxiously this way and that, and sighs that none of the brethren come to see him”. Cassian’s works profoundly influenced Western Christian spirituality—Benedict prescribed reading the Conferences in his monastic rule, and later Western thinkers including Gregory the Great, Alcuin, and Thomas Aquinas drew upon Cassian’s psychological insights. The monastic response to acedia involved “guarding the heart,” sobriety, hospitality, and meditation—practices that anticipated modern mindfulness-based therapies by nearly two millennia.

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Byzantine Medical Continuity (4th-7th Centuries):
Preserving and Advancing Greco-Roman Knowledge

While Western Europe increasingly interpreted mental illness through supernatural frameworks, the Byzantine Empire maintained and developed the Greco-Roman medical tradition. Byzantine physicians followed Hippocratic theory, diagnosing illnesses through examination of the four humors (blood, phlegm, yellow bile, black bile) connected to particular seasons and qualities (hot, cold, dry, moist). Treatment involved dietary changes, pharmaceuticals, bloodletting, and surgery to expunge problematic humors.

Oribasius (c. 320-400/403 CE), physician to Emperor Julian the Apostate, created Collectiones medicae (Medical Collections), “a kind of encyclopedia comprising all the anatomical and physiological medical knowledge of the time”. Though only about 25 of the original 70+ volumes survive, Oribasius’s work “paved the way for Galenism, as he was the first to consider Galen’s works as fundamental for the progress of medicine”. His systematic compilation preserved extensive material from Galen and earlier physicians that would otherwise have been lost, creating “a precious source on the history of ancient and early Byzantine medicine”.

Aetius of Amida (late 5th/early 6th century CE), physician to Emperor Justinian I, produced the Tetrabiblion (16 books), a comprehensive medical textbook that “gives significant information about surgical approaches” and detailed descriptions of various conditions. Aetius was reportedly “the first Greek physician who embraced Christianity”, representing the gradual integration of Christian identity with medical practice. His work “influenced Islamic and European medicine” and drew upon the knowledge of earlier physicians including Rufus of Ephesus, Leonidas, Soranus, and Philumenos.

Alexander of Tralles (c. 525-c. 605 CE) was “one of the most eminent physicians in the Byzantine Empire” who gained “great reputation, not only at Rome, but wherever he traveled in Spain, Gaul, and Italy”. His Therapeutics, written from extensive practical experience in extreme old age, demonstrated sophisticated understanding of mental disorders. Alexander classified melancholia into subtypes based on humoral imbalances: black bile melancholia characterized by depressed mood, anxiety, and delusions; yellow bile melancholia characterized by anger. He recognized that “anger resulted when one transitioned from melancholia to mania,” anticipating by over a millennium modern psychiatry’s recognition of “switch phenomena” in mood disorders. Alexander’s work described over 600 pharmaceutical preparations, including his Twelve Books which “exemplify the use of medicine to treat all types of diseases, including what he described as ‘melancholy’ which modern doctors would describe as depression”.

Paul of Aegina (c. 625-c. 690 CE), educated at Alexandria’s medical school, was acclaimed as the “Father of Early Medical Writing”. His Medical Compendium in Seven Books represented the culmination of Byzantine medical knowledge—“for many years in the Byzantine Empire, his work contained the sum of all available medical knowledge and was unrivaled in its accuracy and completeness”. Paul distinguished 62 types of pulse associated with various diseases and dealt extensively with apoplexy and epilepsy. His surgical expertise was legendary: he performed tonsillectomy, trephination, paracentesis, lithotomy, and breast amputation. Paul’s work achieved extraordinary influence in the Islamic world—his reputation “seems to have been very great, and it is said that he was especially consulted by midwives, whence he received the name of Al-kawabeli or ‘the Accoucheur’”. The Arabic translation by Hunayn ibn Ishaq in the 9th century transmitted Byzantine medical knowledge to Islamic civilization, where it would be transformed and expanded.

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