Ancient psychotherapy? Fifth-century BCE Athenian intellectuals and the cure of disturbed minds

In antiquity, as in our time, insanity was notoriously difficult to treat. ¹ In the Hippocratic tradition, health, mental health included, was construed in the framework of the so-called ‘humoral theory’, expounded in the Nature of Man: the body is healthy, when the quality-carrying bodily humours—blood, phlegm, bile and black bile—are balanced; their excess, shortage or blockage cause disease. ² Hippocratic medicine almost did not recognise emotional and social factors as causes of mental afflictions, and explained all diseases, including psychological and psychiatric disorders, as resulting from physiological causes only. ³ Furthermore, in the Hippocratic literature, with its emphasis on fits of florid madness and lack of interest in borderline mental states, ⁴ moderate deviations from the norm are seldom noted. Following the basic principle of their science, Hippocratic physicians treated all mental ailments, acute and chronic, by physical means, and in order to restore the correct humoral balance, happily prescribed violent purgatives as part of a mad person’s regimen. ⁵ The emphasis on purgation appears to have been shared by Greek physicians belonging to different traditions, and not limited to the Hippocratic school. ⁶ In traditional medicine as well, ‘cleansing and purifications’ were the first remedy to try, if attempts at persuasion did not help, and a person continued to behave strangely. ⁷ Both Hippocratic doctors and traditional healers prescribed drinking hellebore, although the drug was toxic, and could kill easily: one of the Hippocratic aphorisms predicts: ‘Convulsion after hellebore, deadly’. ⁸ It is hard to imagine how these drugs could alleviate mental disease, unless they either served as shock therapy, or acted as placebo. In the words of Guido Majno (1922-2010), ‘hellebore alone could claim a long chapter in the history of human error.’