HIPPOCRATES, HUMOURS, AND MENTAL ILLNESS

PAPER 1: HIPPOCRATES, HUMOURS, AND MENTAL ILLNESS THE CASE

The greatest of the ancient Greek physicians was Hippocrates. Modeling the understanding of the human body on the ancient understanding of the universe, which is made up of four elementsearth, air, fire, and water-Hippocrates argued that the body has four humours, or vital fluids-blood, phlegm, yellow bile, and black bile. In line with the Greek love of symmetry, good health was seen as the result of a proper balance of these humours and illness a result of imbalance. Hippocrates was the first to realize that problems like epilepsy and depression (which he termed melancholia) were diseases of the brain. Just as the elements were warm and cold and moist and dry (fire = dry and warm; earth = dry and cold; air = moist and warm; water = moist and cold), so too were the humours (yellow bile = dry and warm; black bile = dry and cold; blood = moist and warm; phlegm = moist and cold). The heat of the elements, Hippocrates argued, had an effect on the working of the brain and therefore the mind. An excess of heat and the result is fear-think of the effects of being scared: sweating, red face, and feeling flushed. Indeed, this accounted for seasonal changes in mood. Why are we sadder in winter and happier with the arrival of spring? Providing the first ever account of seasonal affective disorder, Hippocrates argued that it was because of the change from heat to cold. But excess heat could be the result of internal imbalances as well. An excess of black bile, for example, would cause the brain to heat up beyond its natural state, resulting in mental illness, specifically melancholia. Depression, according to Hippocrates, is a disease caused by the imbalance of natural substances, a disturbance in the natural harmony of the healthy body.

THE SCIENTIST

Hippocrates (460-377 Bc) was born in Cos, which was home of a sanctuary for the guild of Asclepius, the Greek god of medicine. While Asclepius is mentioned along with Apollo in the famous oath that bears Hippocrates’ name, his approach to medicine was systematic rather than mystical. He devoted significant effort to understanding the causes of epilepsy and pneumonia. Hippocrates was a traveling teacher and healer; his writings are likely the work of students in the Hippocratic School rather than that of Hippocrates himself, although the views expressed and aphorisms contained are considered to be reflective of his views.

YOUR JOB

Read the excerpts of The Nature of Man and The Sacred Disease (beginning on pp. 342 and 343, respectively) and explain Hippocrates’ explanation of mental illness. How do mental states relate to physical states? Explain deductivism. How would a deductivist make sense of Hippocrates’ work? What metaphysical principles are employed? Are there aspects of Hippocrates’ account of mental illness that do not fit in well with the deductivists’ approach?

RESEARCH HINTS •

When reading the historical selection and the philosophical essays, underline passages that express the author’s conclusion and supporting premises. Use these as direct quotations in your paper-type them out and then explain what the passage means and how it is used by the author in his argument. • Structure is very important in a philosophical essay. Make clear what is being argued in each step of your essay by using strong thesis sentences and section headings.

Please reading :

Reading is Hippocrates-The Nature of Man and The Sacred Disease

From Hippocrates, The Medical Works of Hippocrates, ed. John Chadwick and W. N. Mann (Oxford: Blackwell, 1950), 203-5, 19091.

THE NATURE OF MAN

2. I propose to show that the substances I believe compose the body are, both nominally and essentially, always the same and unchanging; in youth as well as in old age, in cold weather as well as in warm. I shall produce proofs and demonstrate the causes both of the growth and decline of each of the constituents of the body.

4• The human body contains blood, phlegm, yellow bile, and black bile. These are the things that make up its constitution and cause its pain and health. Health is primarily that state in which these constituent substances are in the correct proportion to each other, both in strength and quantity, and are well mixed. Pain occurs when one of the substances presents either a deficiency or excess, or is separated in the body and not mixed with the others. It is inevitable that when one of these is separated from the rest and stands by itself, not only the part from which it has come, but also that where it collects and is present in excess, should become diseased, and because it contains too much of the particular substance, causes pain and distress. Whenever there is more than slight discharge of one ofthese humours outside the body, then its loss is accompanied by pain. If however, the loss change or separation from the other humours is internal, then it inevitably causes twice the pain, as I have said, for pain is produced both in the part whence it is derived and in the part where it accumulates.

5. Now I said that I would demonstrate that my proposed constituents of the human body were always constant, both nominally and essentially. I hold that these constituents are blood, phlegm, yellow bile, and black bile. They have specific and different names because there are essential differences in their appearance. Phlegm is not like blood, nor is blood like bile, nor bile like phlegm. Indeed, how could they be alike when there is no similarity in appearance and when they are different to the sense of touch. They are dissimilar in their qualities of heat, cold, dryness, and moisture. It follows then that substances so unlike in appearance and characteristics cannot basically be identical. As evidence of the fact that they are dissimilar, each possessing its own qualities and nature, consider the following case. If you give a man medicine which brings up phlegm, you will find his vomit is phlegm; if you give him one which brings up bile, he will vomit bile. Similarly, black bile can be eliminated by administering a medicine which brings it up, or, if you cut the body so as to form an open wound, it bleeds. These things will take place just the same every day and every night, winter and summer, so long as the subject can draw breath and expel it again, or until he is deprived of any of these congenital elements. For they must be congenital, firstly because it is obvious that they are present at every age so long as life is present and, secondly, because they were procreated by a human being who had them all and mothered in a human being similarly endowed wih all the elements which I have indicated and demonstrated.

THE SACRED DISEASE

17. It ought to be generally known that the source of our pleasure, merriment, laughter and amusement, as of our grief, pain, anxiety and tears, is none other than the brain. It is specially the organ which enables us to think, see and hear, and to distinguish the ugly and the beautiful, the bad and the good, pleasant and unpleasant. Sometimes we judge according to convention; at other times according to the perceptions of expediency. It is the brain too which is the seat of madness and delirium, of the fears and frights which assail us, often by night, but sometimes even by day; it is there where lies the cause of insomnia and sleep-walking, of thoughts that will not come, forgotten duties and eccentricities. All such things result from an unhealthy condition of the brain; it may be warmer than it should be, or it may be colder, or moister or drier, or in any other abnormal state. Moistness is the cause of madness for when the brain is abnormally moist it is necessarily agitated and this agitation prevents sight or hearing being steady. Because of this, varying visual and acoustic sensations are produced, while the tongue can only describe things as they appear and sound. So long as the brain is still, a man is in his right mind.

18. The brain may be attacked by phlegm and by bile and the two types of disorder which result may be distinguished thus: those whose madness results from phlegm are quiet and neither shout nor make a disturbance; those whose madness results from bile shout, play tricks and will not keep still but are always up to some mischief. Such are the causes of continued madness, but fears and frights may be caused by changes in the brain. Such a change occurs when it is warmed and that is the effect bile has when, flowing from the rest of the body, it courses to the brain along the blood-vessels. Fright continues until the bile runs away again into the blood-vessels and into the body. Feelings of pain and nausea result from inopportune cooling and abnormal consolidation of the brain and this is the effect of phlegm. The same condition is responsible for loss of memory. Those of a bilious constitution are liable to shout and cry out during the night when the brain is suddenly heated; those of phlegmatic constitution do not suffer in this way. Warming of the brain also takes place when a plethora of blood finds is way to the brain and boils. It courses along the blood-vessels I have described in great quantity when a man is having a nightmare and is in a state of terror. He reacts in sleep in the same way that he would if he were awake; his face burns, his eyes are blood-shot as they are when scared or when the mind is intent upon the commission of a crime. All this ceases as soon as the man wakes and the blood is dispersed again into the blood vessels.