CHAPTER ONE
Medical and Scientific Understandings
GEORGE KAZANTZIDIS
INTRODUCTION
Hippocratesâ Epidemics 1.9 (2.650â2 L.) describes a deadly outbreak of fever on the island of Thasos with the following symptoms:
Now, those suffering from ardent fever, when fatal symptoms attended, showed signs from the beginning. For right from the beginning there was acute fever with slight rigors, sleeplessness, thirst, nausea, slight sweats about the head and collar-bones, but in no case all over the body, much delirium, phoboi, dusthumiai, very cold extremities, toes and hands, especially the latter. The exacerbation occurred on the even days; but in most cases the pains were the greatest on the fourth day, with sweat for the most part chilly, while the extremities could not now be warmed again, remaining livid and cold.
âtrans. Jones 1923a: 173, modified
The list of symptoms cited above is characteristic of the way in which emotions are evaluated clinically in the Hippocratic corpus (see Fig. 1.1), the earliest collection of medical writings (fifth to fourth centuries BCE) to have survived from Greek antiquity, which will be the focus of this chapter. Phobos, âfear,â and dusthumiĂȘ, âdespondency,â follow upon the observation that some of the patients show signs of mental disturbance. Indeed, when the suspicion is raised in medical texts that a patientâs mind has been affected, along with his or her body, emotions become increasingly significant as symptoms. At the same time, there is no indication that either fear or sadness is highlighted as if they were qualitatively different from the physical symptoms, for example cold extremities, sweat in the forehead, or nausea; in fact, the text shows no awareness of what we would today call patient âpsychology.â In Hippocratic medicine, emotions are most often treated as an extension of the body, rather than independently. In this context, it is highly likely that phobos and dusthumiĂȘ have been adduced by the author as additional symptomsâconfirming simply the presence of excessive coldness in the patientsâ bodies.1 On the whole, even though early medical writers are keen on observingâand indeed develop a rich and refined vocabulary forâemotional anomalies, the overall tendency is to frame âaffectiveâ symptoms in a context which is predominantly concerned with what is happening inside the (material) body: âthe body,â as Peter Singer puts it, âcan be used,â in the medicine of this period, âto give an account of total experience.â2
FIGURE 1.1: Portrait of Hippocrates holding his Apophthegms. Fourteenth-century Byzantine miniature.
The question of how Greek medical science understands the emotions necessarily implicates their relation to the body. In De anima 403a3â20, Aristotle seeks to identify whether the soul exists independently of the body by asking precisely whether the so-called pathĂȘ of the psychĂȘ (a generic term indicating everything that the soul undergoes, including the emotions) belong only to the soul;3 for if it could be proved that such emotions as anger and courage are not shared by the body, it would then follow that the soul can maintain an independent existence (403a10â12). As it happens, the hypothesis is soon dismissedâemotions cannot be experienced unless through the body (403a17â20)âbut Aristotle, as is well known, places emphasis (both in De anima and in the Rhetoric) also on how they are formed mentally by complicated thoughts, evaluations, and judgments:4 thus, for instance, while both anger and fear are accompanied by an unpleasant sensation of pain (lupĂȘ), anger is specifically qualified by the belief that we have been wrongfully mistreated (Rhetoric 1378a31â3) whereas fear is experienced as a mental picture of some destructive or painful evil in the future (Rhetoric 1382a21â2).5
Hippocratics assume a more radical position: while they are certainly familiar with the fact that âfeelingâ involves âthinking,â for the most part they deliberately ignore the fact that emotions can be shaped cognitively by a separate mental faculty, and they prefer to analyze an emotion into its bodily and material coordinates. Aristotle is familiar with this tendency: the issue of what anger is, as we are told in De anima 403a29âb2, can be addressed differently, depending on the perspective we adopt; thus, the âdialecticianâ would try to understand its formal cause, describing it as âa desire for retaliationâ which arises from oneâs judgment that one has been wronged;6 the ânatural scientistâ (phusikos),7 on the other hand, would seek to define it materially, concluding that anger is âthe boiling of blood and hot stuff around the heart.â As we look further into the Hippocratic corpus, we realize that the doctorsâ profoundly âphysicalâ understanding of emotions is not simply a matter of emphasis; on the contrary, it is a calculated attempt to sidestep the idea of a ruling mental faculty and to propose instead that appraisal in affective experience should be viewed as an organismic activity that is distributed across the body and in which the body operates as the prime sense-making mechanism. This is not to say that medical emotions lack âintelligence,â but that intelligence has been subsumed by a feeling and perceiving body which functions as the primary seat of emotion.8 As Michael Frede observes, one of the usual mistakes we make in our approach to ancient philosophical and medical texts is that we âunderrate the physical to the extent that we tend to think of it as being determined by certain ultimate material constituents and a few basic properties of these material constituentsâ;9 yet, when we consider that the distinction between mind or soul and the body is not always evident in ancient sources and that in some of them psychic activity is conceived as a certain disposition of the body (see especially the Hippocratic On Regimen),10 it then follows that thinking or feeling is âsomething that a living body does in virtue of the soul, rather than something which the soul or the mind does for it.â11 In this context, the emphasis placed by the Hippocratics on the raw physicality of emotions will be discussed as a means of assigning to the body an enhanced role as a sense-making, appraising mechanism. The main underlying notion is that there is no need to discuss affect by presupposing a superimposing mental process; rather, it is the body that does the âfeelingâ and incorporates, in all its material dimensions, what we call âemotion.â
EMOTIONS IN HEALTH
Emotions are of interest to medical authors mainly as symptoms of diseaseâas an index of erratic behavior showing that the patientâs body is out of balance. This means that we lack a comprehensive medical account explaining how emotions arise under normal circumstances and how they are related to body and mind in a state of health. The most detailed attempt to speak about emotions in their natural state is found in On the Sacred Disease 14 (6.386 L.)âin a treatise which sets out to explain epilepsy by attributing its origin to the brain,12 the most important of all organs in the human body according to the author:
Men ought to know that from the brain, and from the brain only, arise our pleasures, joys, laughter, and amusement, as well as our sorrows, pains, griefs, and tears. It is especially through this organ that we think, see, hear, and distinguish the ugly from the beautiful, the bad from the good, the pleasant from the unpleasant. Sometimes we judge according to convention; at other times according to what we sense to be in the best for our interests.
âtrans. Jones 1923b: 175, modified
Modern lists of âbasic affectsâ or âbasic emotionsâ typically include anger, disgust, fear, happiness, sadness, and surprise.13 In the Greek passage cited above we can easily recognize the equivalents of happiness/pleasure and sadness/distress.14 Furthermore, although disgust is not explicitly mentioned in the text, we can trace it behind the authorâs remark that the brain helps us distinguish between âpleasantâ and âunpleasantâ things,15 in the same way that it allows us to make aesthetic judgments or ethical decisions. On that reading, disgust would be more directly linked to an appraising processâthan, say, happiness or sadnessâthus approximating to a âhigher cognitiveâ emotion.16 Indeed, it is worth remembering that while disgust is seen by some as a basic affect, assumed to be triggered and executed on a largely automatic basis of instinctive reactions, there are those who argue that âthe word is merely a rough generalizing label that captures the sensation of judging something to have polluting and defiling powers.â17 But with the exception of disgust, the relationship between affects and mental functions in the Hippocratic textâthe latter including phronĂȘsis (âintelligenceâ), sunesis (âunderstandingâ), and diagnĂŽsis (âdiscerning thinkingâ)18âremains for the most part obscure: while the brain is identified as the ultimate source for every psychic power in the body, there is no attempt by the author to discuss in detail the kind of thoughts and judgments that shape our feelings. In fact, when later in the treatise âfearâ (phobos) is added to the list of emotions, its link to the brain is explained strictly in materialist terms: when too much bile enters the cavity of the head and raises the brainâs temperature, a person is seized by phobos, which subsides only after the humour has moved down to the body and back into the veins (On the Sacred Disease 15, 6.388 L.). In the same spirit, it is stated that the heart and the diaphragmâan area of the body that is be...