Bryn Mawr Classical Review 2004.12.11
G.E.R. Lloyd, In the Grip of Disease. Studies in the Greek Imagination. Oxford: Oxford University Press, 2003. Pp. xxi, 258. ISBN 0-19-925323-4. £45.00.
Reviewed by Han Baltussen, University of Adelaide (firstname.lastname@example.org)
Word count: 3203 words
This is an original exploration of literary sources ranging from Homer and tragedy to Hippocratic works, Aristotle and Galen, with the aim of learning more about the Greek ideas about illness and its impact on individuals and society. Framed by a programmatic introduction on anthropological perspectives and a reflective Epilogue, the chapters deal with (2) 'Archaic Literature and Masters of Truth', (3) 'Secularization and Sacralization', (4) 'Tragedy', (5) 'the Historians', (6) 'Plato', (7) 'Aristotle', (8) 'After Aristotle: Or Did Anything Change?'. The texts discussed are collected at the end of chapters 2-8 (with translations -- that this was a brave decision can be seen from the copyright nightmare this creates with the 13 page list of acknowledgements, pp. ix-xxii), and there is a short bibliography and a general index of key terms.
The history of ancient medicine is an exciting and thriving field of research. In the past 10 years important work has been published, and there is an increase of (i) all kinds of projects and collaborations with new approaches, (ii) electronic discussions and exchanges, (iii) new courses and programs.1
Now one of the pioneers of the field, G.E.R. Lloyd (L.), has written an unusual book, which, as L. states, aims to study ideas about disease and how these influenced areas such as "causation and responsibility, about the self and the relation between body and mind, about authority and the expert, about reality and appearance, and about good and evil" (p. iii). If you ever wanted to read an accessible account of how ancient medicine affected Greek society, culled from literary sources, this book certainly makes a good starting point. I wondered to what extent the title and cover (Heracles and the hydra, Caere -- Getty Museum) were the idea of the publisher: they might mislead readers into thinking that L. will deal with the dramatic impact of disease ("in the grip" sounds rather dramatic), but that is only true in a restricted sense; the cover plate is a beautiful picture but has a rather tenuous link to disease and medicine -- Heracles had shrines for his role as healer (one mention on p.53) -- unless it is to suggest a connection with the use of Hydra's blood as poison on Heracles' arrows.
This set of essays has its origin in a series of lectures between 1997-2000, but they reflect L.'s engagement with the topic for more than 30 years (p. iii). L. discusses the attitudes towards disease in the early and classical Greek literature, claiming that "the full grip that disease had on the ancient Greek imagination has yet to be revealed" (p.iii). He does not explain what he here means by "imagination", but it must have something to do with the echoes in literary texts rather than those of a 'scientific' nature (cf. p. 176 where with reference to Aristotle he announces discussion of "the idea of disease in different areas of his work -- and its grip on his imagination"). Similarly, the title no doubt takes its cue from the remark on p. iii, but the dramatic ring of "grip" is illustrated only implicitly by the diversity of sources used, with material drawn not only from scientific writings, but from almost every literary genre.
In his introductory chapter L. articulates certain themes and anthropological perspectives such as the influence of literacy on the growth of skepticism (4), but these are programmatic rather than omnipresent or fully integrated beyond the introduction (they return more prominently in the Epilogue). His aims are very ambitious (his words, 8), though not fully realized: to deal with interrelated genres and themes synoptically (5, 13). L. specifically claims that the synoptic approach he is taking is new. The themes are disease as linked to ideas of the self, causation, purification and pollution, expertise and authority, the impact of diseases on both individuals and society, and the soul-body analogy. As this list shows, L. is mostly concerned with ideas about disease. One cannot help but feel he is overstating his case somewhat, but we certainly find many interesting observations in his reflections on a body of texts which usually is not the main focus of treatments of ancient science.2 No doubt much will need further development beyond this particular study (cf. his Preface, p. iii and iv).
The overall argument aims to show that from Homer down to Aristotle we can learn a lot about the values of a society by looking at its ideas about illness. Lloyd offers no explanation for his chronological limits, nor for his method of selecting texts within those limits. Important questions are: Who were regarded as healers or doctors? What kinds of cures were used? How does disease relate to ideas about well-being and good and evil? L. also closely analyses crucial terms and their "semantic stretch". Here he repeats his well-worn complaint that it is unhelpful to label certain forms of speech or ideas as "metaphorical", since this presupposes a too-rigid dichotomy between "a supposed primary, literal, use and other deviant ones" (p. 8-9).3 His alternative, expressed in the phrase "semantic stretch", may help to remedy the dichotomy-problem. But we may agree that meanings get stretched, and yet still find it useful to count some of the most extremely stretched usages as metaphorical. We may agree with Lloyd that there is no sharp cut-off between literal and metaphorical uses, but to conclude that we cannot recognize even the clear cases of the literal and metaphorical at the extremes is to fall for an instance of the sorites paradox. But if we do not over-generalize, L. may well be right that in the case of medical terms it is not useful to divide them by categories into the 'literal' and 'metaphorical'.
In ch. 2 L. leads us through familiar texts, while providing new insights along the way. Homer, Hesiod, Sappho, Epimenides and Empedocles get such a treatment, under the heading "Archaic Literature and Masters of Truth". The latter part of this title comes from Detienne, the French anthropologist, as we learn on the last page of the chapter, where L. initially links it only to Empedocles (the term returns several times later, see index). The early authorities in Greek literature give a look-in on authority and the source of knowledge about diseases and their causes (mostly divine, though they can also have human cause e.g. poem 31 by Sappho -- what Dodds called double determination [L. p.22 n3]), yet this authority is never quite unchallenged, and thus the question arises what the attitude is towards the involvement of the gods in diseases.
Another important point is made in Ch. 2, focusing on who knows what the cause of a disease is. In Homer's Iliad, Achilles is already sure it is Apollo before the seer is consulted (15). The god bringing the plague represents the early view that some diseases are a punishment for an offence, and those who deal with them, using drugs, are mostly seers (ἰητήρ), women and foreigners (e.g. Helen in Odyssey 4). Hesiod goes further in emphasizing the ambivalence towards women (Pandora) and in suggesting that justice and health are connected. This view foreshadows ideas about causation and more rational approaches.
Chapter 3 follows on from these points, but opens up another interesting issue, the relationship between "Secularization and Sacralization". It looks at the "concurrent rise of two sharply contrasting attitudes and approaches to disease and cure" (41), viz. 'natural' explanations and the continued (and invigorated) status of temple healings. The exponent of the new scientific approach is the author of On the Sacred Disease, who rails against the charlatans, magicians and others who claim the gods as causes of illness. His systematic countermoves opt for nature and causes of disease as natural, though, as L. points out, without fully eliminating the divine: by declaring nature as divine, he is "able to neutralize his opponents' view that there is something special about the sacred disease" (46). It is the shift to 'nature' as a distinct concept that allows the new approach to give natural causes a more important place in medicine. The second theme of this chapter is the rise of Asclepius as part of the continuing temple healing. Here inscriptions are pressed into service (mostly 4th c. as L. emphasizes). It is clearly shown that there is common ground between the traditional and temple healing methods (use of dreams, terminology, prognosis), which helpfully clarifies the complex relationship between the two domains. Both provided help with mental and physical troubles: while Hippocratic healing targeted diseases on the basis of empirical evidence and description, religious (temple) healings would offer solace. Both would have to rely on "plausibility of their approach ... rather than on any obviously verifiable record of success in procuring cures" (60-1).
Tragedy also deserves a place in this study (Ch. 4), since it reflects (archaic?) views on disease as punishment/pollution that requires a cure through purification. L. is mostly concerned with King Oedipus and the Bacchae, the former allowing insight into Sophocles' views on how to cure disease (possibly sceptical about naturalistic approaches), the latter presenting a case of mental illness. There is more emphasis on analysis of terminology here (e.g. pharmakos as "scapegoat" 88, with note for further literature). L. notes the interesting shift from Hesiod's general thesis that disease is punishment for unjust behaviour to a more ambivalent curse of a family history. In Euripides we can learn "about the powers and dangers of the divine, about the perils of madness and its being confounded with good sense" (94). L. rightly states that we can get a lot out of the plays because of "what these plays assume their audience will understand and respond to" (96).
In their activity of presenting their contemporaries with an account of events (past or present) the historians Herodotus and Thucydides offer "a good deal ... about disease" (Ch. 5). What is interesting here is of course the critical aspect of their approach. In Herodotus we do find the view that disease is divine retribution (1.167; 2.111; 4.202-5), but he does not always endorse stories he reports. Not surprisingly a tension arises between tradition and rationalization. In Thucydides' account of the Peloponnesian War the plague at Athens looms large, and L. compares his account with that from the Hippocratic Epidemics, arguing that Thucydides is "the diagnostician of natural ills and moral ones" (126). But a distinct difference between him and the Hippocratics is that he believes that the plague has "one single general pathology" (ibid).
Ch. 6 looks at Plato's views on medical issues. Anyone familiar with the Timaeus will not be surprised to see Plato included here. Plato discusses diseases in analogies, associating order with health, and analysing soul by analogy with the body (L. uses Gorgias, Republic, Phaedrus, and Timaeus). Other comparisons are found in his work, e.g. when the philosopher kings are said to use 'noble lies' as a pharmakon. Only the expert is allowed to do this, just as the doctor administers drugs or applies surgery. Plato clearly knew enough about medicine, but the use of it for his moral and political analysis is not without its problems (e.g. disanalogies). It is made clear that Plato adapted the model of balance within opposing forces to fit his cosmological message, in which the natural state of things and possible disruption of that balance becomes, more than ever before, a matter of harmony: in the Timaeus "notions of order, proportion harmony span the fields of politics, morality, 'physics' (the nature of things), and the body in particular" (156). It is here that L. sees an unprecedented use of traditional notions in medicine, which has echoes in the Republic and Laws.4
Ch. 7 deals with Aristotle and a number of aspects of his use of (concepts from) medicine. No elaborate theory of disease by Aristotle survives, but he says quite a bit about how the healthy state of the body is preserved or threatened. For instance, Aristotle tries to draw the distinction between a doctor and a natural philosopher: while they both enquire into first principles and causes of diseases, the latter's objectives is more theoretical. Yet his insistence on first principles against those who do not address this aspect would be considered too narrow an approach by some (e.g. On Ancient Medicine) introducing non-verifiable factors into an experience-based science (179). Aristotle also uses the analogy of the body as state (On movement of Animals) and the state as a body (Politics), in which the healthy organism is a model for the "well-run" state. Health can also be normative and influences accounts of moral values. The famous idea that moral excellence is a (dispositional) mean between excess and defect also assumes that there are absolute values: the good person will be "a judge of right and wrong" (182). On several occasions Aristotle uses health as a model in analogy, for instance, comparing it with politics (though his emphasis of the expert's empirical approach differs sharply from Plato's trust in expertise full stop). L. points out that Aristotle's term for "deviation from true political system" is parekbasis which evokes a sense of abnormality or lack of soundness, while Ar. assumes that "true constitutions are the natural ones" (186). Last but not least L. discusses katharsis of emotions (the context is now literary criticism, Poetics 1449b24 ff.). L. suggests that the medieval view of katharsis, not the cognitive view (Nussbaum), explains "the reciprocity involved in katharsis of certain emotions through them" (187). He goes for further clarification to the account of music in the Poetics. The three types distinguished (ethical, active, enthusiastic) all have their use, and can all provide relief and katharsis (e.g. 1342a10f.). The question is how this relates to the claim from the Politics, and L. suggests that the right way to understand this link is that Ar. is proposing that tragedy is not a cure for a medical problem (something which the medical line of interpretation might suggest), but of "the emotions that fall within the range of anyone's experience". Here we should not forget that Ar. speaks specifically about pity and fear in both works. The chapter ends by reiterating the connection between physics and medicine, centered around the concept of phusis.
Ch. 8 presents a kind of epilogue (but see the final chapter), which reflects on the results and tries to pull the threads together. Its title has the question whether anything changed after Aristotle, carrying an echo of one of L.'s early books (Greek Science After Aristotle London 1973). It makes clear what an important moment Aristotle's death was, marking the end of an era. It is here also that L. (re)defines his topic in clearer terms than at the start of the book "whether anything changed from the classical period to late antiquity on the issues we are concerned with, the attitudes to, preoccupations with, and understanding of, disease" (202). L. argues that the changes we can observe in that post-Aristotelian period are "peripheral and unimportant" in comparison with similarities. He then goes through a number of aspects (dissection in Alexandria, the range of medical theories, the importance and influence of Galen esp. regarding anatomy, and the widespread disillusion with theory). He continues with a discussion of the theories of disease and whether the approach was naturalistic or not, and the relative ignorance some philosophers displayed about advances in medical theories. Their concern was more and more an ethical one, focusing on happiness and the 'passions' (pathe), in which the study of nature was not relevant except to have an "understanding of the basic constitution of the universe" (206). Feelings became an all-important part of this discussion, as they clearly affected on a person's psychological balance, and the progression from Plato onwards is one of redefining feelings in such a way that they come under the control of the rational part ("intellectualizing tendency") which goes the other way when it comes to diseases of the soul: there is a tendency to pathologize the intellect (208). The Stoics in particular specialized in psychotherapeutics, and here L. prescribes caution in studying them since the sources are often hostile (Galen5). The final part discusses Galen and Lucretius (and Aelius Aristides) as sources that show that belief in the role of the gods continued and no agreement existed on diseases and their cures. Temple treatments continued to thrive, and their therapies, L. suggests, may have had equal effect on body and soul (216).
As intriguing and often original as this study is, there are a few points that call for comment. L. has chosen a format which aims at a wider audience, as is clear from explanations of technical terms, from his own statement of wanting to make his argument "concise and clear" (p. iv; in this he is successful). Yet at the same time he is engaging with existing issues in academic debate, which would require detailed knowledge of the text and the literature. Occasionally this makes for somewhat esoteric reading, where views are constantly qualified as 'not subtle enough', or 'too rash' without discussion -- there are quite a number of bees buzzing in the bonnet here. Thus, for example, it is not easy to see the relevance of the remark that it is "rather unclear" (p.14) what it means for Homer to be known as the educator of the Greeks. Of course one can only do so much in a short chapter but opening such 'cans of worms' in such a brief remark could be both tantalizing and puzzling for the less experienced reader.
Even if we grant L. that he will not be comprehensive (Preface, p. iii), additional material could have been fitted in. One would have thought that a very interesting recent interpretation of Thucydides' description of the plague in Athens deserved a mention,6 or the discussion of many of the same texts on the role of doctors from a recent conference.7 Presumably the choice is to focus on the texts and their interpretation first and foremost, yet in those aspects in which the book presents itself as a pioneering study, it might also have assumed the role of a guide to secondary sources (the primary ones are there), directing the curious reader to relevant recent work (as L. does do for "scapegoat" in Ch 4, p. 88n, above).
The book is beautifully edited and elegantly written, reflecting L's experience and authority: the whole account looks deceptively straightforward, but its broad scope and the originality packed into these pages are indisputable. With the Greek passages in an appendix at the end of the chapters this booklet could even serve well as a reader or as the core text of an upper level seminar. I have found few printing errors (a garbled opening sentence in the third paragraph on p.41 -- perhaps an unfortunate residue of a draft version; "have have" bottom of p.52). This is the kind of study that should provoke further discussion in the history of medicine, not only on the scope of relevant sources, but also on interdisciplinary approaches (hence my position that this short book deserves a long review). It is a useful and stimulating contribution to an area in which much remains to be done.8
1. I mention just a few examples here: (i) H. King, Women's Bodies in Greek Medicine (Routledge 1998); R.J. Hankinson, Galen. On Antecedent Causes, edited with an introduction, translation and commentary (CUP 1998); J. Longrigg, Greek Rational Medicine from Alcmaeon to Alexandria (Routledge 1998); R. Flemming, Medicine and the Making of Roman Women: Gender, Nature, and Authority from Celsus to Galen (OUP 2000); P. van der Eijk, Diocles of Carystus. The Fragments 2 vols (Brill 2001-2); id., Ancient Histories of Medicine: Essays in Medical Doxography and Historiography in Classical Antiquity (Brill 1999); (ii) e.g., The Society of Ancient Medicine (SAM) run by Lesley Dean-Jones (Austin, Texas), with regular news on PhD theses; cf. Médicine Ancien in Paris; (iii) e.g., in the UK a new program in History of Medicine has been established in Newcastle with the help of a Wellcome Trust Enhancement Award (see the website); the internet abounds with pages related to courses on the history of medicine.
2. Sources and translations are all numbered meticulously (e.g. T 3.13 = text 13 in ch. 3) and listed separately; they include Hippocratic writings, Pindar, tragedians, Plato, Aristotle, Lucretius, Celsus, Galen, Aelius Aristides, inscriptions. They take up approximately 94 pages of the 258 page book (ca. 40%).
3. Cf. G.E.R. Lloyd, Aristotelian Explorations, CUP 1996, ch. 10.
4. See also D. Henri's review in Human Nature Review 3 (2003) 381-88, esp. n.12 and text thereto. Cf. Rebecca Flemming, "Pestilence and punishment" in Times Literary Supplement, 2/20/2004 Issue 5264, p. 28.
5. Another is Plutarch. For a thorough analysis of Galen's reading of Chrysippus' psychology, see T. Tieleman, Galen and Chrysippus on the soul: argument and refutation in the De placitis, books II-III (Brill 1996) and of Chrysippus' work id. Chrysippus' On affections : reconstruction and interpretations (Brill 2003).
6. See D. Sedley, Lucretius and the Transformation of Greek Wisdom (CUP 1998), pp. 57, 163-5 on the plague in Thucydides and Lucretius.
7. One he himself attended see H. Yunis (ed.) Written Texts and the Rise of Literate Culture in Ancient Greece (CUP 2003) in which Lesley Dean-Jones in "Literacy and the Charlatan in Ancient Greek Medicine" 97-121 has a striking overlap in passages discussed. Would TLG searches for ἰατήρ be the cause of this? (I suspect that by now the impact of the TLG on research methods and outcomes in Classical Studies deserves its own special study.)
8. I note that the paperback version has just been published (OUP, 2004, ISBN 0-19-927587-4).