psychology_Sons_(2003)

Theory and Practice in the Classical Period 307

for telling the difference between right and wrong, and, al-
though such persons must be restrained, they should be
treated for their insanity and not punished for the crime. The
McNaughten Rules are still applied in Great Britain and in
some states of the United States. (See chapter by Brigham &
Grisso in this volume.)

THEORY AND PRACTICE
IN THE CLASSICAL PERIOD

The humoral/pneumatic theory of disease, which originated
in fifth century B.C. Greece and was elaborated by Galen
in Rome in the second century, was the dominant medical
theory in the Western world until the eighteenth century—an
extraordinary longevity.

Classical Medical Theory

What we know about theories of medical practitioners in
ancient Greece we have derived from the Hippocratic Cor-
pus,a collection of 60 to 70 medical writings that includes
theoretical papers on the nature of disease in general and of
various illnesses in particular. It contains specifics of diagno-
sis, descriptions of therapies, case histories intended to teach
theory and practice to physicians, and papers apparently writ-
ten as lectures intended to publicize a physician’s work as
well as to present to laymen information about how to main-
tain health. The whole of the Corpusis often attributed to the
Greek physician Hippocrates (ca. 460–367 B.C.) but, varieties
of style of the papers make it evident that they were written
over a long time span by various people (Lloyd, 1978).
The theories of disease presented in the Corpusare bio-
logical and materialistic. No clear demarcation exists be-
tween “physical” and “psychological” disease; all disease
was attributed to some sort of imbalance in the natural state
of the body, which provided an explanation of the hidden
cause of diseases. Certain papers emphasized the importance
of the humors (fluids) in the body. They conjectured that by a
blending process called “pepis” or “coction,” various bodily
organs convert food into humors, but reached no consensus
as to the number or origin of the principal humors although
bile and phlegm were usually mentioned. Diagnosis was
based on close observation of specific symptoms, especially
of every secretion, and changes in the patient’s vital forces,
nutrition, body heat, mood, and memory.
The theory of humors, elaborated by Galen in the second
century, became the basis of medical theory and practice
until the eighteenth century. The four humors considered es-
sential for life were blood, phlegm, choler (yellow bile), and

melancholer (black bile). They were concocted by various

bodily organs from the primal elements taken into the body

from the heat of the sun, air breathed, and substances in-

gested. The humors varied in their qualities along the two

axes of hot–cold and moist–dry. Health required a balance of

the relative proportions of the humors, and anything that

interfered with proper coction of the humors resulted in dis-

ease. Three types of madness were distinguished—phrenitis,

mania, and melancholia. Phrenitis was diagnosed when fever

and delirium were present. Mania was characterized by ex-

treme excitement similar in the absence of fever. Melan-

cholia was differentiated from phrenitis by lack of either

excitement or fever and was usually attributed to an excess or

corruption of black bile (melancholer). Melancholia could

be engendered by psychological stress and could lead to

serious physical illness and even death. (The termmelancho-

liareferred to a specific pathology now called depression.

The termmelancholyevolved to denote a wide spectrum of

psychopathology.)

The Doctrine of Pneuma

Since living creatures die when they are deprived of air, it

followed that the life force must require a substance in the

air breathed, which led to the hypothesis of “pneuma,” a

superfine material essential to life and growth, in which

motion is inherent. It was conjectured that pneuma, distin-

guished from the psyche or soul, is present at the very begin-

ning of life, assists all physiological and psychological

functions, and is renewed by breathing and digestion. Because

blood pulses as if impelled by a vital force, it was assumed that

pneuma is transported by the blood throughout the body, and

further assumed that pneuma is stored in the ventricles of the

brain (Brett, 1963). The paper “The Sacred Disease” in the

Hippocratic Corpusstates that the air breathed in leaves

behind in the ventricles of the brain “its vigour and whatever

pretains to consciousness and intelligence [and,] the move-

ment of the limbs” (Lloyd, 1978, p. 250)—for example,

pneuma. “Therefore, when the blood-vessels are shut off from

this supply of air by the accumulation of phlegm...thepa-

tient loses his voice and his wits” (Ibid, p. 243); hence, the

brain is the seat of the “sacred” disease (probably epilepsy).

Note that at the time, and for many centuries after, the brain tis-

sue itself was not believed to have any psychological function.

Medical and Other Treatments

Treatment consisted of bloodletting and herbal drugs with

emetic or purgative properties to remove excess or corrupt hu-

mors, and of herbal extracts, nourishing food, and stimulating