Galen’s time working in the medical profession must often have led him to reflect on ethical questions. A doctor, he thought, should be friendly, compassionate, and modest when dealing with patients and also act with both empathy and authority. In reality, though, doctors do not always conduct themselves in this manner. Galen tells an old anecdote about the Hellenistic doctor Callianax, a student of Herophilus: “This Callianax visited a patient and the latter complained to him about his condition and said: ‘I am dying!’.” Callianax did not reply with what most patients, ancient or modern, would hope to hear: “He said in response: ‘Patroclus died and he was much better than you!’.” Galen uses this to reflect on his own times: “Among contemporary physicians there are people who are still so impolite in their dealings with patients that the latter come to hate them, while others behave in the opposite manner, that is, they display the eagerness of a slave, use flattery, and are despised as a result.”
The book under review is a study of Galen’s views on ethics. As Trompeter makes clear in the introduction, Galen not only held views on ethics in relation to medical practice (e.g. topics such as how doctors should or should not conduct themselves towards patients, like the story about Callianax), but also about ethics as generally understood. Trompeter’s aim is to focus on the “foundations of Galen’s ethical approach” (p. 11). It is a large and interesting subject.
The book is arranged into two long chapters. The first chapter, “The Natural Foundation of Ethics: Galen’s Moral Psychology”, focuses on Galen’s understanding of the soul-body-mind connection and the psychological and bodily processes that might lead to good or bad decisions or actions. The second chapter, “Galen’s Ethical Approach”, looks at various topics in his understanding of rationality, irrationality, and moral character.
The book begins with a biographical note about Galen’s life. Trompeter gives a good, short overview of Galen’s training, focusing more on his philosophical position and perspective than on his medical career: “His whole life seems to have been an admirable process of learning,” she comments. Trompeter then turns to look at his personal life, especially his relationship with his father and mother (“She was perpetually shouting and fighting with my father,” Galen tells us), and the absence of any mention of a wife or concubine or children in any of his writings. Trompeter comments that perhaps Galen “saw no advantages in family life,” then adds “but this is all speculation.” Then come two paragraphs where Trompeter seems to skirt the thorny issue of Galen’s own moral character, first by discussing his views on the genders, and then by asking if he was ambitious mainly in becoming “a doctor for rich men with power and distinction.” Trompeter’s comments here probably stem (understandably) from her reflections about whether or not the man saying so much about ethics and morality practiced what he preached, but it seems a little out of place to comment on this so briefly when it needs a lot more nuance and depth. Examining the moral character of someone like Galen would make for an interesting larger study and would probably fill up an entire book.
The main body of the book pursues many fascinating and fruitful avenues of research. The various sections of the book are devoted to working through Galen’s most significant statements on this topic or that, contextualising them, and exploring the interpretations that have emerged in the secondary literature. The reader is quickly interested by the ideas posed, the extensive ancient quotations, and the ancient and modern debates.
The main points along the way are these: Chapter 1.1: Galen’s conception of a person being ruled by three principles, one in the head (imagination, memory, reflection, knowledge, thought, ratiocination), one in the heart (the tone for the soul, constancy, and a source of heat), and one in the liver (nutrition, enjoyment of pleasure, intemperance, licentiousness). Chapter 1.2: Galen’s conception of voluntary action. Why do people decide to do something? Galen says there are different causes, such as reason, desire, or spirit, and the rational and irrational powers of the person can fight against each other. Chapter 1.3: Galen’s conception of how emotions and the body interlink (e.g. people die from fear “when a naturally weak little soul is seized by a strong affection and is all at once extinguished and choked,” Galen says). Chapter 1.4: Galen’s conception of how and why a constant strong emotion can cause imbalance and lead to a pathology (e.g. constant anger or constant sadness eventually become bad enough to be thought of as diseases of the soul, for which someone would need serious treatment). Chapter 2.1: Galen’s views about the rationality of little children (“When children reach their second year … they smile and laugh at their nurses and they want to hit and bite those who hurt them”) and his understanding of how some rational capacities appear at birth while others take time to develop. Chapter 2.2: Galen’s definition of character traits (are our characters integral to our natures from birth, or can they be learnt through education?). According to Marvazi’s The Natures of Animals, Galen said that “A character trait is a state of the soul that induces someone to perform his actions without consideration or precise knowledge.” For Galen, excellence of the soul and body already appear at birth, and education and upbringing can help or hinder this. In Hygiene, Galen also makes the interesting comment that “the character of the soul is destroyed by bad habits in food, drinks and exercises, by sights and sounds, and by music in general”—i.e. care for the body is also care for the soul. Chapter 2.3: Galen’s understanding of the difference between errors (caused by bad beliefs) and affections (caused by non-rational impulses) and how these apply to ethics. For example, Galen says how when Odysseus returns to Ithaca finding the suitors running rampant, his non-rational impulse is to kill them all immediately but his reason tells him to wait until the right moment and thus prevents him from making an error (“If Homer is not clearly describing in these lines a battle of anger against reason in a prudent man, the victory of reason and the obedience of anger to it, then there is nothing else that anyone would concede that I understand in the poet,” Galen says). Chapter 2.4: Galen’s views on the relationship between medical ethics and religion and on the role of the divine in ethics and human nature.
This is an enjoyable volume that deserves attention not only from scholars of ancient medicine but also from anyone interested in ethical questions. I found Trompeter’s final argument, namely that Galen’s approach to ethics is creative and innovative and does not merely parrot earlier thinking, to be convincing. There’s no doubt, too, that Galen’s writings on ethics have a flavour that can rarely be found in other ancient authors, as for instance in his countless personal anecdotes, as when he talks about how small moments shaped his viewpoint (“In my youth … I once saw a person hurrying to open a door and, when the operation did not proceed as required, biting the key, kicking the door, cursing the gods; rolling his eyes wildly as madmen do, and all but frothing at the mouth like a boar. I hated this rage so much that I would never be seen thus disfigured by it”). As Trompeter notes in the introduction, her book closely follows on the heels of Sophia Xenophontos’ Medicine and Practical Ethics in Galen (2023), but the focus is different and the two books complement each other well.