Mesopotamia

Mesopotamia, found in modern Western Asia, is the oldest documented ancient civilization. Findings over the last two centuries have revealed a highly advanced and innovative Mesopotamian society, with established art, medicine, architecture and law domains. Therefore, it is unsurprising that Mesopotamian tablets contain information about symptoms and treatment of mental illness.

Ancient Mesopotamians believed that the ṭēmu (human reason) or the libbu (the human inside) are prone to illness (Parys, 2014). Illness was the work of sorcery and supernatural forces, and a healer could help remove any evil affecting the individual (Geller, 2015; Parys, 2014). Mesopotamian doctors distinguished between mental and physical illnesses and their observations included descriptions of psychosomatic symptoms (Geller, 2015). Texts from the times of the Babylonian empire reveal doctors describing the symptoms of various modern mental disorders, including anxiety, obsessive-compulsive disorder, and depression (Reynolds & Wilson, 2013). For example, the symptoms of depression found in Mesopotamian texts include; the inability to eat, difficulty sleeping and memory loss (Geller, 2015). Although there was no name for the disorder, it is clear that ancient doctors understood the distressing effects of the combination of such symptoms and the need for their treatment.

Since Mesopotamians believed that illness was rooted in the supernatural, it is unsurprising that the treatments were often related to appeasing supernatural deities (Geller, 2015). Texts reveal that a recorded method for treating depression included a ritual marriage of male and female figurines and the sacrifice of a sheep. Other treatments of depression included wearing a necklace of herbs and minerals and chanting incantations. Interestingly, incantations for treating mental disorders showed how doctors had a good understanding of the symptoms of mental illness, as different incantations targeted different distressing emotions, such as guilt, anger and helplessness.

Although ancient Mesopotamians believed psychological distress to be the result of magic and the supernatural, they demonstrate a good understanding of the distressing effects of negative emotions, and the need to treat them.

References

Geller, M. J. (2015). 1: Medicine as Science. In Ancient babylonian medicine: Theory and practice. essay, Wiley-Blackwell.

Parys, M. (2014). Introduction to mental illness in Ancient Mesopotamia. Erişim Tarihi, 1, 2018.

Reynolds, E. H., & Wilson, J. V. K. (2013). Depression and anxiety in Babylon. Journal of the Royal Society of Medicine, 106(12), 478-481.

Stol, M. (2000). Psychosomatic suffering in ancient Mesopotamia. In Mesopotamian Magic: Textual, Historical and Interpretative Perspectives (pp. 57-68). Brill.

Egypt (**SC)

Written by: Mazen Elkhayat

Most would assume that our current understanding of physiological psychology, the branch of psychology concerned with the brain mechanisms underlying behaviour and perception, can be attributed to the use of modern, technologically advanced techniques (Nasser, 1987). However, findings relating to the nervous system have been reported as far back as the times of Ancient Egypt. Not only did Ancient Egyptians localize the site of cognitive functions in the brain, they also assessed attention, memory and consciousness in routine medical examinations, similar to modern neuropsychological assessments. Furthermore, various Ancient Egyptian texts reveal a much more sophisticated understanding of anatomy and physiology than previously thought.

The Edwin Smith Papyrus

Named after Edwin Smith, an American Egyptologist who obtained the papyrus in 1861, the Edwin Smith papyrus is a medical text detailing brain injuries (Kamp et al., 2012). The Papyrus itself is thought to be written around 1600 BCE, but it may be a copy of an older document dating back to 3000 BCE. The papyrus is thought to be the first surgical manuscript. One of the sections of the Papyrus outlines the process of conducting a medical examination for ancient physicians. Not only does this section emphasize the importance of looking for signs of lesions of the brain and dura mater, but it also includes a list of questions about the neurological condition of the patient, including their level of consciousness, ability to speak, etc.

Diagnosis is another focus of the Papyrus. The Papyrus sorts brain injury cases based on the location of the injury relative to the skull. The level of anatomical detail is remarkable, with differential diagnoses to ascertain different types of frontal, temporal or zygomatic-temporal fractures. Treatment recommendations are tailored to the condition of the patient. For example, in cases where the patient has high intracranial pressure, the Papyrus suggests the patient should sit upright to relieve the pressure. The document also discusses spinal injuries and associated symptoms, revealing the Ancient Egyptians’ understanding of the different functions of various parts of the spinal cord (van Middendorp et al., 2010). For instance, cervical injuries to the spinal cord were associated with the inability to rotate the neck, while lumbar injuries were linked to impairments in leg movement.

The Edwin Smith Papyrus, with its neat organization, focus on empirical observation, and astonishing anatomical detail, rivals modern atlases and references.

The Ebers Papyrus

Whereas the Edwin Smith Papyrus describes neurological conditions, the Ebers Papyrus describes a variety of psychiatric conditions (Bou Khalil & Richa, 2014). Written around 1500 BCE, the Ebers Papyrus contains sections from sources dating back to 3400 BC. The document details how to assess immaterial aspects of mental function, such as consciousness and mood fluctuations (Nasser, 1987). The Papyrus also contains references to mental disorders, such as depression and even suicidal thinking. However, the manuscript attributes aspects of mood disorders to the heart and the circulatory system, rather than to the brain (Bou Khalil & Richa, 2014). While this physical attribution to mental disorders might be considered erroneous given our current knowledge, modern studies have shown a link between mental disorders and physical health, like depression and the cardiovascular system for example. People with major depressive disorder are at a higher risk of developing cardiovascular disease, pointing to a correlation between the two afflictions (Chauvet-Gélinier et al., 2013; Bou Khalil & Richa, 2014).

The Ebers Papyrus reveals that Ancient Egyptians concerned themselves with the causes of mental disorders, and although their predictions were not correct, they demonstrate a sophisticated ability to hypothesize about the human condition.

References

Bou Khalil, R., & Richa, S. (2014). When affective disorders were considered to emanate from the heart: The ebers papyrus. American Journal of Psychiatry, 171(3), 275–275. https://doi.org/10.1176/appi.ajp.2013.13070860

Chauvet-Gélinier, J.-C., Trojak, B., Vergès-Patois, B., Cottin, Y., & Bonin, B. (2013). Review on depression and coronary heart disease. Archives of Cardiovascular Diseases, 106(2), 103–110. https://doi.org/10.1016/j.acvd.2012.12.004

Kamp, M., Tahsim-Oglou, Y., Steiger, H.-J., & Hänggi, D. (2012). Traumatic brain injuries in the Ancient Egypt: Insights from the Edwin Smith Papyrus. Journal of Neurological Surgery Part A: Central European Neurosurgery, 73(04), 230–237. https://doi.org/10.1055/s-0032-1313635

Nasser, M. (1987). Psychiatry in ancient egypt. Bulletin of the Royal College of Psychiatrists, 11(12), 420–422. https://doi.org/10.1192/pb.11.12.420

van Middendorp, J. J., Sanchez, G. M., & Burridge, A. L. (2010). The Edwin Smith papyrus: A clinical reappraisal of the oldest known document on spinal injuries. European Spine Journal, 19(11), 1815–1823. https://doi.org/10.1007/s00586-010-1523-6

Greece

Plato (~428-347 BCE)

The ancient Greek philosopher Plato heavily influenced Western culture with his ideas on philosophy, science and law. His stance on the human soul is most relevant to psychology, and reveals the views on mental illness during the classical period.

Plato believed that human beings had a psyche, or a soul, and that this immortal soul was separate from the body, and the body cannot be animate without the soul (Lorenz, 2009). In Plato’s Republic, he states that the soul is divided into three parts: reason, appetite, and spirit, with each part explaining different facets of human thinking and behaviour. Reason is the rational capacity of the soul responsible for critical thinking, appetite seeks basic gratification (food, drink, sex), and spirit is a driver of action. Plato believed that when these parts of the soul work harmoniously, the soul is able to achieve its ultimate goal, which is living a life of virtue.  Plato described that conflict occurs when the parts of the soul are not in harmony.

In Timeaus, Plato does further in-depth about the conflicts of the soul (Zarewicz, 2016). He states human beings actually have two souls. The soul created by god is located in the head and is responsible for intelligence, rational thinking and striving for morality. The other soul is located below the neck and is responsible for human desires. Plato further describes the connection of organs to the souls. The heart, for example, receives messages from the “upper soul” and regulates the function of the organs in response. As for the cause of “mental sickness” (anoia), Plato states that it is the illness of the soul is caused by disorders of the body. The two kinds of mental sickness that Plato describes are madness and ignorance. In these cases, the person is either preoccupied with pleasure or pain, and cannot think rationally. Plato also describes that negative emotions, such as worry, sadness and forgetfulness are caused by the displacement of bodily humours (fluids).

In order to treat illnesses, Plato prescribes maintaining a physical and mental balance (Zarewicz, 2016). To remain healthy, the individual should exercise and also participate in philosophical thought. For mental illnesses specifically, Plato recommends withstanding desire, and using reason to remain on the path of virtue. Plato believed that giving in to desire made humans more like animals, and less like the gods, the latter of which humans should strive to be.

Aristotle (384 BCE-322 BCE)

Aristotle, Plato’s student, is another prominent figure in Western philosophy. He is considered to be one of the first scientists, as he formed his theories based on observational evidence. His views on psychology, which he considered a science, are revealed in De Anima.

Aristotle believed psychology to be a science which studies the soul (Shields, 2020). Compared to Plato, who believed the soul to be immortal and separate from the body, Aristotle thought the soul could not survive without the body. In this way, he viewed the psyche as a living being which is related to its biological structure (Humphreys, n.d.). Aristotle believed that all living beings had a soul, however, there is a hierarchy of souls based on their capabilities. (Kenny, n.d.). With every new level, the soul preserves the qualities of the previous level, but has additional qualities the previous level does not have. For example, the plant soul has the ability to grow and reproduce, and while the animal soul does too, animals also have the ability to perceive and sense. The human soul has all the previous capabilities, however, it can also think and reason.

On perception, Aristotle believed that information from the environment is absorbed using the five senses (Kenny, n.d.). However, there are two types of sensory objects, those that are perceived by one sense (as colour is perceived by sight or sound is perceived by hearing) or those that are perceived by multiple (as motion can be detected by sight and feeling). Aristotle believed that humans had a “central sense” that combined information from multiple senses when encountering a singular object, and this combination helped determine what the object is.

Aristotle did not provide much new insight into mental illness, and stated that “mad” people can be ignored as they do not have much reason (Ahonen, 2018). However, Aristotle did say that individuals can demonstrate disordered behaviour without being ill. Aristotle describes manic and melancholic mood states, however, he also states that such mood states can have their benefits. For example, manic individuals can be great artists due to their spontaneity.

References

Ahonen, M. (2018). Ancient philosophers on mental illness. History of Psychiatry, 30(1), 3–18. https://doi.org/10.1177/0957154×18803508

Humphreys, J. (n.d.). Aristotle (384 B.C.E.—322 B.C.E.). Internet encyclopedia of philosophy. Retrieved from https://iep.utm.edu/aristotle/#SSH3aiii

Kenny, A. J. P. (n.d.). Philosophy of mind of Aristotle. Encyclopædia Britannica. Retrieved July 18, 2022, from https://www.britannica.com/biography/Aristotle/Philosophy-of-mind

Lorenz, H. (2009). Ancient theories of soul. Stanford Encyclopedia of Philosophy. Retrieved from https://plato.stanford.edu/entries/ancient-soul/#3.2

Rome

Galen (129 AD-216 AD)

Galen, an ancient Greek physician living in Rome, greatly contributed to the fields of Roman philosophy and medicine.

Born into a wealthy family, Galen had the privilege of growing up being taught by an extremely educated father (Galen Biography, 2022). Growing up, Galen attended the lectures of many philosophers and realized that individuals must not rely on only one source of information when learning. Galen travelled around the Roman Empire while receiving his medical training, and in 157, he ended up in Pergamon to be a physician for gladiators. His time spent there allowed him to gain great insight into the human anatomy and lead to him being one of the most famous physicians in Rome. Throughout his life, Galen wrote many works on medicine, anatomy, and relevantly, psychology.

Although Galen had no significant commentary on the immortality or substance of the soul, he upheld Plato’s tripartite theory of the soul, believing that different parts of the soul (reason, appetite, spirit) have different functions and reside in different bodily organs (brain, heart, liver, respectively) (Schiefsky, 2012). Galen believed that “reason guides humans towards good, appetite towards physical gratification and spirit towards honour”(Schiefsky, 2012, p. 336). There is psychological balance when “reason is in charge, spirit is obedient, and appetite is weak” (Schiefsky, 2012, p. 336). Galen also describes that the brain, heart and liver each control specific physiological processes, as they have their own duct systems. For example, the brain controls movement using the nerves, the heart increases the pulse throughout the body using the arteries, and the liver is responsible for nutrition through the veins.

In On the Natural Faculties, Galen provided insight into human personality. He attributed the variability in human temperament to the four bodily fluids, the humours (Stelmack & Stalikas, 1991). Galen described that the mixture of the four humours, phlegm, blood, yellow bile, and black bile, created the individual’s temperament. Galen believed that people with the best temperaments had a balance of all four humours. An individual with an excess of a certain humour had one of the four types of worst temperaments; sanguine, choleric, melancholic and phlegmatic. For example, if an individual had an excess of black bile, they were considered melancholic and demonstrated symptoms of depression. Although this “humour theory” has long been disproven, it demonstrated that Galen had an appreciation for differences in personality, and made one of the earliest attempts to explain them.

References