Theory and Practice in the Classical Period 309accounts for individual differences in susceptibility to differ-
ent kinds of disease. Temperament is evident in body type,
and it follows that prognosis is improved if the body type is
identified.
By Galen’s time the existence of nerves had been recog-
nized. Herophilus (ca. 355–280 B.C.) and his contemporary
Erasistratus (ca. 330–250 B.C.) had traced some of the nerves
to the brain and concluded that nerves must provide the “con-
duits” for the passage of pneuma to and from the brain, hence
nerves must be hollow. They theorized that sensation occurs
when pneuma that conveys impressions of the external world
flows through the nerves toward pneuma stored in the ventri-
cles of the brain. The flow outward from the brain is directed
by the psyche through the nerves to various muscles, inflating
them to initiate action. Galen developed the final form of this
doctrine to construct a theory of psychophysiology that in its
general outline remained influential through the eighteenth
century.
According to Galen, pneuma, the basic principle of life,
and originates from the general “world spirit.” As pneuma
ascends through the body to the brain it is progressively re-
fined into natural spirit, vital spirit, and animal spirit. The
quality of pneuma could be adversely affected by a variety of
agents, including “vicious humors,” toxins, poor diet, inade-
quate sleep. Severe pain and, notably, excessive passions
(such as sexual lust, rage, greed, grief, fear, and great joy) in-
terfere with attention, memory, imagination and thought, and
could eventuate in melancholy or mania. As had Plato and the
Stoic philosophers before him, Galen viewed emotional
states as a form of mental disorder, and commented that “the
passions have increased in the souls of the majority of men to
such a point that they are incurable diseases” (Jackson, 1969,
p. 380). Hence a salubrious climate, proper diet, good diges-
tion, adequate sleep, proper exercise, and freedom from per-
turbation of the soul by the passions are essential to preserve
health. Galen recommended that those with mental health
disturbed by passions receive education designed to promote
self-understanding, governance of the expression of the pas-
sions, and capacity to delay acting when in a passionate state
in order to reflect and choose a rational course of action. Such
education ideally should be provided by a mature man, him-
self free from passion.
Galen identified three types of melancholia: one in which
the brain is directly affected by overheated blood and black
bile, one in which the brain is secondarily affected by blood
corrupted by black bile throughout the whole body, and one
(“hypochondriasis”), in which the brain is secondarily af-
fected by black bile in the abdominal organs (the hypochon-
drium), particularly in the stomach, which Galen believed to
be intimately connected to the brain. Hypochondriasis is
characterized by severe digestive disturbances and flatulence;
because proper coction of humors was assumed to depend on
good digestion, it followed that digestive disorders would be
a significant cause of melancholy. The notion of hypochon-
driacal melancholy was still current in the seventeenth cen-
tury (see Burton, 1654/1927) and being described in the
eighteenth century. By the twentieth century, hypochondria-
sis had come to mean a morbid concern about one’s health.
Melancholy tends to occur in individuals constitutionally
inclined to the disorder. Galen observed that melancholy
was more common in men but tended to be more serious in
women, and that it occurred sometimes in young persons,
was uncommon in persons in the prime of life, and was so
common in older people that it could be considered an almost
inevitable result of advancing age. Individuals who suffer
from melancholy are usually, but not always, sad and fearful;
some wish to die, others fear death. Symptoms of melancholy
described by Galen included incoherent speech, mutism,
amnesia, and elaborate delusions. A melancholy patient
might be delusional, yet be otherwise sane. Instances of delu-
sions mentioned by Galen include the conviction of a patient
that he was made of glass and feared being broken, the belief
of another patient that he had no head, and beliefs of being
poisoned or chased by demons. Galen’s case histories were
plagiarized throughout the course of medical and psychiatric
history—and were, perhaps, plagiarized by Galen from
others before him.
Galen recommended the traditional treatments of blood-
letting, purgations, herbal remedies, and a regimen of exer-
cise and nutritious diet, and suggested that sexual intercourse
could be beneficial. He is known for his emphasis on the use
of drugs (which came to be called “galenicals”) in the treat-
ment of disease, although most of the drugs he used were not
original with him. Galen discussed hysteria, believed caused
by disease of the uterus, which was not considered a form of
madness because psychological symptoms were not an es-
sential aspect of the disorder. Although Galen believed that
the uterus could be displaced from its normal position, he
rejected the ancient idea that the uterus could be freed from
its attachments to move about the body. Like earlier medical
theorists, Galen believed that hysteria was a disease of
unmarried women and widows as a result of their being
deprived of sexual intercourse.
Galen’s writings were synthesized and elaborated by later
Greek authors. Although the medical schools of Athens and
Alexandria continued to function at least until the seventh
century and some medical treatises, largely based on Galen’s
teaching were written, interest in scientific medicine de-
clined in Western Europe after the fall of the Roman Empire.
Waning interest may have derived from decreasing numbers