Introduction Galen, the Unsuspected Moralist

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London (UK): Cambridge University Press ; 2023 Dec. Contents Search term < Prev Next > Introduction Galen, the Unsuspected Moralist This study is devoted to the ancient medical theorist and practising physician Galen of Pergamum (129—ca. 216 AD), whose fundamental contributions to specialised branches of the medical art (e.g. anatomy, physiology) made him an authoritative model in the field of medicine up to the seventeenth century. Taking his cue from his idealised master Hippocrates, the father of medicine in classical antiquity, Galen married medicine with philosophy, thereby establishing a robustly scientific system for researching, teaching and writing about the workings of the human body and the origins and treatment of disease. 1 In this way Galen seems to have actualised what he fervently proclaimed in his short essay The Best Doctor is Also a Philosopher , namely that the ideal physician should be armed with logic, physics and ethics, the three structural pillars of philosophical discourse in antiquity. 2 Yet Galen is exceptional in other respects too. He is antiquity’s most voluminous author, with his output surviving in Greek (there is more in Latin, Arabic, Syriac and Hebrew) filling twenty-two massive volumes 3 in Karl Gottlob Kühn’s nineteenth-century edition, an extraordinary number by any standard, whether ancient or modern. 4 Such sheer quantity is already reflected in the (also rare) autobibliographical inventories that he composed to authenticate his writings, in an attempt to stop what we would term intellectual property theft. Galen’s productivity comes with notable diversity in subject matter, form and orientation, from didactic manuals on anatomical, therapeutic and prognostic theory at varying levels, to Hippocratic commentaries, polemical tracts against individuals and medical sects (e.g. the Methodists), (exegetical) works on Platonic or Aristotelian philosophy, as well as texts on demonstration, lexicography and philology. Interestingly, his oeuvre includes a distinct body of works on moral philosophy (περὶ τῶν τῆς ἠθικῆς φιλοσοφίας ἐζητημένων), which comprises twenty-three titles of ethical tracts, catalogued in his On My Own Books . 5 Of these works, three have come down to us: Affections and Errors of the Soul (περὶ τῶν ἰδίων ἑκάστῳ παθῶν καὶ ἁμαρτημάτων τῆς διαγνώσεως, in Greek) 6 , Character Traits (περὶ ἠθῶν, in Arabic summary) and the long-lost Avoiding Distress (περὶ ἀλυπίας, in Greek). The majority of the other book titles taken together point to these texts’ affinity with essays on applied or practical ethics, a fashionable philosophical product by Galen’s time, though the genre goes back to the Hellenistic period. 7 As the name suggests, practical ethics sought to offer handy tips on how to think about the world and conduct oneself in it, so as to cope effectively with the hardships of everyday life. It also furnished advice on how to take care of one’s body and soul, face the challenges arising from politics and other professional activities, and handle potential frictions and tensions while connecting with peers, friends and family. In doing so, it transcended scholarship and special interests, extending into the realm of human relationships in an accessible manner that moral learners could easily make sense of, regardless of their professional expertise. Practical ethics is also known as popular philosophy, 8 not because it is addressed to the masses or because it involves a lower level of sophistication, 9 but because of its appeal to a broader category of readers/listeners, who were nevertheless educated enough to be attentive to their character development and self-management. 10 Though theoretical moral philosophy emanated from and spoke to a restricted group of philosophical specialists, practical ethics reached out to a much larger audience as ‘a life-project to which any thinking person ought to feel obliged to subscribe’. 11 Galen’s moral works fall squarely within this generic tradition. As can be surmised from their titles, they concern three interrelated areas: first, the regulation of conduct in daily cultural practices, such as rhetorical demonstrations in the forum or private discussions in aristocratic villas. 12 Second, the mitigation of negative emotions especially germane to elite life in the High Roman Empire, for example, slander, flattery, love of honour or desire for fame. 13 And third, the cultivation of moral uprightness, rooted in modesty and affability, widely 14 (even if not universally) considered defining features of cultured individuals ( pepaideumenoi ) throughout the Mediterranean world in this period. 15 All three strands attest to Galen’s heightened alertness to practical philosophy and its social embedding, and help substantiate what is otherwise only evident from passing references in other parts of his corpus regarding the role of the ethical discipline, namely that it is beneficial in promoting purity, justice, friendship and happiness, as well as being open to anyone who shows an interest in it. 16 In keeping with the spirit of the age, Galen seems deeply sensitised to the importance of practical philosophy both as a book topic and a way of life. Alongside his dedicated collection of moral treatises, which we have just surveyed, he also produced a good number of other texts that are steeped in moral(ising) influences and associations, despite the fact that they are not recorded among his ethical works in the autobibliographical lists. As a matter of fact, the heading and content of some of these works might at first sight point to their affiliation with other domains of Galen’s oeuvre, e.g. prognostic theory ( Prognosis , Chapter 8 ) or empiricism ( Exhortation to the Study of Medicine , Chapter 5 ), but what unites them all is their ethical-psychotherapeutic value and the way they help reconstruct Galen’s programme of emotional wellbeing. And that is not all. Galen also imbued his technical tracts – both medical and philosophical – with moral reflections or overtones. The passages in question are sometimes concerned with representing Galen’s high moral character ( ēthos ) as opposed to the villainy of his medical rivals. On other occasions, they delve into the gloomy ethical realities of present-day society or what Galen describes as the debased status of medicine compared to its morally flawless classical past. At other times, the teaching and learning of medicine itself is infused with moral lessons, and scientific accounts acquire a moral component often in the form of sermonising digressions or asides, which demonstrate the social importance of ethics in Galen’s thought-world. Quotations from moral authorities or other material with a moral-didactic message reflecting popular morality are also utilised in non-ethical contexts, thus sharing widely held principles of the second/third-century Imperial state and foregrounding its solid ethical foundations. In their totality, these scattered passages exploring ethics, together with the essays overtly designated as ethical and the individual works of a moral-psychotherapeutic nature form a relatively small proportion of Galen’s overall production. But they still constitute an integral part of the author’s mental mapping. The aim of this study is to piece them together, assess them for the first time in a holistic manner, and offer a new and robust framework in which we can comprehend Galen’s role as a practical ethicist. This is an aspect of his intellectual profile that has been little studied and poorly understood up to now. 17 As I plan to show, the cornerstone of his contribution to this area that makes him influential, if not original, in ancient terms is his creative intermingling of medicine and practical ethics. Giving prominence to this dynamic interdisciplinarity in its social, philosophical and cultural context will transform our current understanding of Imperial-period literature on moralia as known from other thinkers. It will also give us new insights into popularised forms of ancient medical literature, refine our sense of ‘medical philosophy’ or ‘philosophical medicine’ through an emphasis on its ethical dimension that has previously been left out of relevant discussions, and provide a fresh vantage point from which to observe the social role of medicine. Last but not least, this more comprehensive reading of Galen’s moralising discourse will advance our understanding of the range of possibilities as regards representing key areas of the study of Imperial culture more generally, and notably athletics or the symposium. Contribution and methodology Galen’s relationship with ethics is not a foregone conclusion or a straightforward matter. For, unlike key moralists such as Plutarch or Musonius Rufus, who were mainly philosophers who participated to some extent in political affairs, Galen’s primary occupation was that of a doctor and medical writer. True, he espoused a kind of medicine that was intimately bound up with philosophy and tended to accentuate his self-perception as a physician-cum-philosopher. 18 Yet technically he is the only medical expert we know of to have systematically engaged with ethics. Rufus of Ephesus (first century AD), the Anonymous of Paris (first century AD), Aretaeus of Cappadocia (second century AD) or Celsus (second century AD) discussed psychopathology and psychotherapy, but hardly touched on philosophical training or moral topics in general. 19 Other doctors who straddled the boundaries between medicine and philosophy, such as Asclepiades of Bithynia (ca. 120 – 90 BC), Athenaeus of Attalia (fl. end of the first century BC), Sextus Empiricus (ca. 160 – ca. 210 AD) or Soranus of Ephesus (second century AD), might have been good candidates for surveying moral traits, 20 yet they too were not strongly attracted to them except for what they could contribute to pathology. For when moral traits feature in their nosological accounts, they are limited to their impact on the patient’s corporeal health or behaviour. 21 The same emphasis on the primacy of the body over the soul features in Athenaeus and Soranus, who, as has recently been shown, were keen to explore the role of early education proper, habituation and intellectual study, but only in as far as they related to shaping a healthy body. 22 For the above-mentioned authors, then, matters of the soul are subordinate to somatic wellbeing, and are therefore a means to an end, that of the recovery of the body’s strength and the alleviation of its sickness. This attitude on the part of medical authors is taken to extremes in a contemporary declamation, which stages a dispute between a doctor, a philosopher and an orator regarding which of their disciplines is the more useful to the community. 23 The doctor makes a strong case for medicine, of course, reducing philosophy’s role to moral philosophy in particular, 24 which he debunks. His main argument against it is that moral philosophy concerns few people ( ad paucos pertinent ), clearly having theoretical moral philosophy in mind, and that character is inborn ( mores nasci ), hence moral philosophy is rendered useless, having failed to ‘cut out vice’ ( amputant vitia ). At the end of the declamation, the doctor exalts medicine’s utility by focusing only on the way it preserves the body’s wellness, in line with Athenaeus and Soranus above. Though a doctor himself, Galen not only did not subscribe to such notions, but also constructively opposed them through his pragmatic promotion of life-long moral development, 25 something that does not seem to have found an equal articulation in (near)contemporary medical discourse (more on this issue in Chapter 2 ). Some scholars have briefly considered Galen’s medical ethics vis-à-vis Hippocratic deontology. 26 Others have dwelled on his indebtedness (or lack thereof ) to earlier psychological and moral traditions by looking at relevant texts as sources of philosophical concepts and arguments. The burgeoning work on Galen’s philosophy of mind since the 1990s especially has provided us with a considerable body of theorisation on the ancient doctrines concerning the structure and function of the soul/mind and its relation to the body, mostly discussing the physical causation (humoral imbalance) and the pathologies of psychological disturbances. Examples include melancholia , phrenitis , mania , epilepsy, hallucinations and the like, 27 all nosological conditions which we would today place within the realm of psychiatry. 28 The focus in this book will be on moral passions and not mental malfunctions, which are not ‘diseases of the soul’ (νοσήματα τῆς ψυχῆς) in the way that Galen and others understood harmful passions to be, 29 albeit he sometimes mingled the two groupings. 30 The same emphasis on theorising obtains in the more recent scholarship on ethics per se , which again privileges descriptive models and typologies (for example, in relation to emotions or proposed psychotherapeutic practices), 31 glossing over Galen’s moral agenda and its pragmatic impact on various spheres of the life of the contemporary upper classes as depicted in his works. 32 While taking into account the conceptual underpinnings of Galen’s practical ethics, this study seeks to investigate the sophisticated ways – literary, rhetorical, argumentative or other – in which this doctrinal material is deployed by Galen so as to make his moralising more accessible to the reader. To put it another way, when it comes to Galen’s voicing of moral ideas it is not the ‘what’ but the ‘how’ that interests me. This study highlights the fact that Galen’s ethical instruction is tailored to suit various contexts, genres and target audiences, and it foregrounds in particular the social dynamics of his didacticism, which is aimed at enhancing his audience’s morals not in any abstract or absolute terms, but bearing in mind the special conditions of the community they live in, against a backdrop of situational variability. Galen’s moral tracts and passages are examined in their own right and for their own interpretative, communicative or performative merits, not as repositories of philosophical tenets, but as lively textual entities, which convey moral concepts to an informed audience and actively reform their moral positions, while elucidating and debating their contemporary social and cultural ambience, in line with a new-historicist perspective. 33 For instance, the claims of the elite to social mobility and promotion, the power struggles they were often caught up in and the expectation that they should be highly educated and morally upright ( kaloi kagathoi ) are some of the factors that Galen as ethicist had to address, if he wanted to come across as practical and useful to the consumers of his moral advice. Our knowledge of the moral climate of the Graeco-Roman period in the light of Greek testimonies has significantly improved thanks to recent work on Plutarch’s practical ethics ( van Hoof 2010 , Xenophontos 2016a ), Epictetus’s pedagogical approach ( Long 2002 ), and Imperial-period popular (not high) morality ( Morgan 2007 ). So the present book seeks to add to this trend by illuminating a hitherto unappreciated and idiosyncratic exponent of philosophical writing on how to lead the good life in this era. Thus the core question that this book addresses is: What is Galen’s contribution to the popularisation of moral philosophy in relation to and beyond his proficiency in medicine? Other key questions tackled are: How does Galen adjust his moral guidelines to fit the needs and requirements of contemporary life at the top? What techniques does he employ in assigning himself moral authority on different occasions? And, at the end of the day, to what extent could the exercise of reading Galen’s works on medicine and practical ethics in tandem rather than in isolation reshape our image of Galen and his times? This study ultimately aims to amend the scholarly view that sees Galen’s ethical writing as an opportunistic by-product, intended for professional self-advertisement amidst the agonistic structures of the Imperial world. 34 It is true that medicine was at the time a notoriously contentious occupation. In the absence of any formal educational qualifications, as we understand them today, or any socially sanctioned regulation of their profession, medical practitioners in antiquity often needed to boast of their individual skills and erudition to cement their authority, discomfit their rivals and win the trust of patients, powerful friends or patrons. The competition for distinction took place not just in bedside group-consultations or the anatomical demonstrations that proved popular urban spectacles, but also in public lectures and disputations as well as in the area of authorship of medical works. The epigraphic record shows that elite doctors also competed with one another in ritualised medical contests, such as the Great Asclepieia in Ephesus, taking place in front of large crowds of onlookers. That said, such unhelpfully broad generalisations regarding the combative nature of medicine cannot be applied heedlessly to the interpretation of Galen’s ethical work. They need to be nuanced and evaluated against the astonishing diversity of moral capital that permeates the Galenic corpus, unmatched in the work of any other ancient physician. The energy, passion and time he spent on the creation and dissemination of such a quantity of moral material shows that for Galen ethics was not just a passport to social and professional advancement, but rather translated into a conceptual apparatus for delivering the lessons he wished to give in the morals of his day. That is not to say that self-promotion is wholly excluded from this process. Self-promotion is involved in as far as Galen needs to impose the required authority to hold forth about how things are morally and to construct a moral world for himself and his audience while surpassing other ethically inadequate doctors and superficially speculative philosophers. By the same token, the tendency to explain Galen’s moral project in the light of his dependence on the rhetorical and sophistic elements of Imperial culture also needs to be revisited. As a moralist, Galen would have naturally used his convincing rhetoric to put across his ethical message as efficiently and broadly as possible (what I call ‘moralising rhetoric’). Consequently this book approaches the rhetorical and persuasive functions of ethics from a different angle from that embraced by most recent literature, i.e. not as engendering vain self-glorification in medicine, but as a socially beneficial exercise in self-advertisement, a powerful resource that helped Galen establish himself as an active and efficient moral philosopher, entrenched in the society in which he lived and operated. In that sense, this book offers a novel assessment of Galen’s public role by approaching him as a teacher of ethics, whose instruction sought to have a positive influence on the daily lives of different members of society, with a wide range of pursuits and ambitions, both private and public. Galen’s broad ethical agenda suggests that he was not just keen to treat bodies but souls as well; to (re)form character, modify moral mistakes, console, caution, provoke, problematise and even reprimand, as necessary, for what he believed to be a shared morality in his contemporary world. In pursuing this agenda, I shall be exploiting a deliberately wide range of hermeneutic tools, such as literary analysis (including issues of genre, structure and organisation, and narrative texture, e.g. shift of grammatical subject, style, intertextual echoes, and linguistic predilection), and an extensive set of rhetorical and other discursive tactics that enable our author to promote ethics, bolster his self-characterisation or underpin his rapport with his in-text addressee(s) and by extension wider audience. The close-reading analysis is informed by modern methodological approaches to the understanding and explication of ancient texts, such as emotion theory, narratology, Pierre Bourdieu’s theory of class fraction, Michel Foucault’s observations on morality and frankness of speech, and the sociological theory by Peter Berger and Thomas Luckmann that helps construe the operation of certain vices in the medical encounter. Theoretical models from the modern anthropology of ethics also offer some support to the interpretation of Galen’s modes of moralism in Chapter 1 , whereas positioning theory is used in the Conclusion to offer a lens through which to focus on the different types of role-playing in Galen’s moral relations to his medical and philosophical colleagues, as described in different parts of his work. Overview of Chapters This book consists of two Parts. By surveying the breadth and subtlety of Galen’s moralising interventions in mainly non-ethical works, Chapters 1 – 3 (comprising Part I ) seek to provide a systematic account of the main moral themes and types of moralism in Galen. Among these, the most general level is represented by an unparticularised moralism, in which the author pronounces ethical verdicts with universal application. Galen’s aim here is not to override moral relativism (in the modern sense of the term) nor restrain moral freedom. Rather, he seeks to delimit what he wishes to stigmatise as deviant behaviour as lucidly as possible, so as to be able to offer rudimentary directives for goodness effectively. In this model of basic moralism, even though there are instances where the author’s moral viewpoint features in a commanding fashion, reference is made to an astute reader who either embraces, upon reflection, Galen’s viewpoint or judiciously considers what is at stake when the former goes astray. That is particularly true also of the test cases from technical works, especially those dealing with physiological psychology, which are discussed in Chapter 2 . These show that Galen’s resourceful combination of popular philosophy and medicine is intended to promote mental alertness in his readers in various aspects of their personal and social lives, such as the symposium or the area of maintaining good health (hygiene). The control of emotions and the social embeddedness of ethics that Galen emphasises in these passages while at the same time describing the physical basis of character formation, make him stand out from other medical authors inasmuch as they reveal his proposed vision of a moral form of medicine, which is the subject of Chapter 3 . This Chapter explains in detail how Galen endows medical science with moral probity. In broad outline, he extrapolates moral principles from his ethical programme to feed into his medical accounts and thus reveal his personal responses to what he represents as the immorality of other doctors. Assigning praise and blame or stressing social shame and fear are central moral-didactic devices here, as is reproach with a view to moral amendment or Galen’s attempts at self-deprecation in order to affect his readers’ moral activity. The findings of Chapters 1 – 3 are thus designed to offer a solid interpretative basis for better understanding the features of Galen’s moralising in individual texts with an ethical provenance ( Avoiding Distress , Affections and Errors of the Soul ) or an ethical character ( Exhortation to the Study of Medicine , Recognising the Best Physician , Prognosis ) that are the focus of the ensuing five Chapters of this book ( Part II ). Chapter 4 examines Galen’s credentials as an ethical philosopher in the light of his recently discovered essay Avoiding Distress . It argues that his moral agenda which is expanded upon here makes him an active participant in the practical ethics of the High Roman Empire, with a more profound attentiveness to popular philosophy than is usually admitted. Galen’s dialogue with what has been termed ‘Stoic psychotherapy’ and the Platonic-Aristotelian educational model helps build up his ethical influence through an engagement with the past. On the other hand, his individual characteristics, such as the autobiographical perspective of his narrative and the intimacy established between author and addressee, render Avoiding Distress exceptional among essays (whether Greek or Latin) treating anxiety, especially when compared with the tracts on mental tranquillity written by Seneca and Plutarch. Another distinctive element of the treatise is that Galen’s self-projection as a therapist of the emotions corresponds to his role as a practising physician as regards the construction of authority and the importance of personal experience. Finally, the diligence with which Galen reformulates similar pieces of moral advice in his Affections and Errors of the Soul – a work that is different in form and intent from Avoiding Distress – bears witness to the flexibility of his practical ethics and the resourcefulness and adaptability with which he presents it. Chapter 5 turns the spotlight on the rather overlooked treatise Exhortation to the Study of Medicine . It argues that in this work Galen constructs or conjures up images of young readers, intending it to act as an educational manual in moral intensification for prospective medical students. Therefore, this Chapter demonstrates how Galen’s concern for his reader’s acculturation might explain the appropriation of advice and the selection of relevant material from a long-established protreptic tradition. In discussing Galen’s moralising methods and the pedagogical elements of the essay, this Chapter also draws links between Galenic and Plutarchan moralism, dealt with in detail for the first time, and thereby arguing that Galen’s moral writings need to be construed in the light of Imperial-period practical ethics. That proposition receives further support from the special features of Galen’s protreptic discourse discussed in this Chapter, especially practicability and effectiveness resulting from the author’s philosophical leanings (e.g. his Platonic-Aristotelian background) and medical expertise (the mechanics of the body and his emulation of Hippocrates in the second part of the essay). Chapter 6 centres on Galen’s longest moral work, the Affections and Errors of the Soul , and explores the features of Galenic practical philosophy from a number of angles. The first section of the Chapter provides an analysis of the work’s programmatic preface and shows that Galen exploits the dynamics of polemic, self-promotion and self-effacement to cast himself as a prominent contributor in this intellectual area. The next section discusses Galen’s emphasis on self-knowledge, which is often blocked by self-love. It claims that in order to generate feelings of revulsion with regard to the latter, Galen works on ‘class fraction’ as a tactic with moralising intent. Another strand of special importance in the essay is the figure of the moral adviser, which Galen elaborates on so as to highlight the need for welcoming and indeed enduring moral criticism. Even though the moral adviser features in other authors of the Second Sophistic (the renaissance of Greek letters from roughly the first to the third century AD), in Galen it points to the applicability of ethics to a broad range of social contexts, thus, I would argue, credentialling his situational ethics. A separate section of Chapter 6 focuses on the concept of free speech ( parrhēsia ). While Galen debates the challenges of social and political interaction, he advises frankness at all costs. A genuine friend should never be reluctant to express the truth of someone’s moral situation and this makes him strikingly different from the flatterer, a disgusting stock figure in Imperial works on moralia , particularly in Plutarch, whom Galen seems to follow here. Another shrewd device that Galen uses to good effect to achieve the moral rectification of readers is the presentation of images involving the body and soul. These instigate the aesthetic evaluation of negative emotions. To that end, the description of the pathology of anger (its origins and results) brings out the destructive impact of this passion, particularly in the episode featuring Galen’s Cretan friend, which is framed, I suggest, as an ‘ethical case history’, sharing characteristics with Galen’s clinical accounts of patients that are aimed at showing how to treat the body (medical case histories). The practical tone of Galen’s ethics is also evinced in his account of insatiability and his overall tactics of not simply proposing courses of action but most importantly inciting critical responses from his readers as to how best to handle certain emotional conditions, given that the ascetic lifestyle is not an option for Galen. Social and political realities always impinged on a person’s moral stance in the Graeco-Roman era and so Galen also taps into the idea of social shame/honour to shape a personal sense of restraint. Chapter 7 sets Recognising the Best Physician at the heart of its discussion, moving the focus from popular philosophical works to tracts of social commentary that are rich in ethical references or subtexts. I suggest that, despite its content being closely related to the material discussed in The Best Doctor is Also a Philosopher , the latter contains a more generalised advocacy of how the proper doctor ought to behave, whereas Recognising the Best Physician restricts its focus to treating Galen’s individual virtues, and renders self-projection more central to the narrative. This enables Galen to provide a more pragmatic account of the connection he envisaged between medicine, ethics and society, and place the morally didactic function of medicine in particular at the forefront of his intellectual horizons. I highlight how Recognising the Best Physician offers a plethora of passages discussing moral issues, for example the emphasis on the value of truth over deception, the issue of flattery and the ethical corruption of contemporary society. I show that to better illuminate the immorality of his medical colleagues, Galen, inspired by philosophical intertexts, notably the Republic and the Gorgias , creatively likens them to wicked and dissimulating orators. By also attributing features of self-interested politicians familiar from Platonic metaphors to contemporary charlatan physicians, Galen recategorises his rivals’ abilities and undermines their moral standing to suggest that the ideal kind of medicine to combat public disorder is the moral medicine embodied by himself. To that end, Galen sketches himself as a Platonic helmsman, entrusted with a humanistic vocation and safeguarding social and political stability. In Galen’s enlightened understanding of medicine, I argue, the medical art is an approved form of politics, well adapted to respond to the chaos tormenting his society under the Empire. Hence, authorial self-praise is not always (or necessarily) linked to rhetorical self-affirmation, but rather, at least in Galen’s case, fosters a potent vision of an edifying type of medicine, which it is hoped will provide practical remedies for the corruption of contemporary Rome. This squares with Galen’s practical ethics as proposed in other Chapters of this book. The final Chapter ( Chapter 8 ) shows how close Galen is to the style and language of a practical moralist by focusing on the previously neglected moral aspects of Prognosis . The rich ethical material that Galen includes on the way his society functions and the role of physicians is construed as moral reportage, which also enables him to provide the image he constructs of himself as a medic with profoundly moral features. The essay’s preface stresses the quest for truth and the exercise of correct judgment as moral principles advocated by Galen for physicians and all other professionals as thinking beings. This, I suggest, has a strong theoretical background expounded upon in Galen’s ethical work, pointing to his ideological coherence on ethics and its uniform application across texts of a (seemingly) different purpose. The preface is also informed by Galen’s perception of the morality of doctors addressed in the Therapeutic Method , which I see as a sibling account of Galen’s conceptualisation of medicine as a virtuous art. Furthermore, the delineation of moral character is made central to Galen’s notion of the proper physician, which explains the fact that he formulates his text in such a way as to distinguish himself and his peers from charlatans and sophists, a group of moral outsiders traditionally depicted as quarrelsome and vainglorious. This Chapter also discusses the sophisticated discourse on malice and contentiousness that Galen sets up within the context of some of his medical case histories. The analysis of the writing technique and structure of the case histories as much as of the characters involved offers unique insights into Galen’s account of emotions, especially their causes, consequences, theorisation and phenomenology. In Prognosis Galen is not just the narrator of the account but also a protagonist in the plot. In the highly aggressive confrontations described in this text, Galen outranks all others, especially figures with no obvious links to philosophy, such as the physician Antigenes. However, in the face of philosophical luminaries, such as the Peripatetic philosopher Eudemus, Galen retreats: he accepts moral advice and aspires to emulate Eudemus as an ethical exemplar. These well-integrated tales stage moral controversies through multiple role playing and thus bring out the power dynamics of philosophy in social intercourse. The dialogues between the characters embody moral lessons of considerable importance, and the reactions of the characters themselves help make several ethical points, albeit with different degrees of explicitness. This Chapter concludes by stressing how in these instances Galen’s medical activity impinged on the formation and sometimes the development of his moral ideas. In Prognosis ethics emerges as a robust area of thought, study and professional performance in Galen. At the end of this study, I provide a substantial summary of the scope, techniques and features of Galen’s ethical discourse and its close interplay with his medicine to illuminate in conclusive mode that Galen’s moralism is idiosyncratic, wide-ranging and broadly systematic with a notable degree of conceptual consistency. Through the key results of my research into the wide spectrum of Galenic moral and moralising works and passages, I hope to have shown that the concepts of freedom from detrimental passions, ethically charged responses to social and professional trials, prudent adjustment and self-sufficiency are only some of the staples in his moral representation of thinking beings in the Imperial world, attesting to the fact that Galen’s ethics is morally sited. By the end of this book, I also hope to have penetrated below the surface appearance of Galen the physician and medical writer and consolidated his image as a distinctive ethical author and practical moralist of the High Roman Empire. Footnotes 1 We are fortunate to have three dedicated biographies of Galen by Nutton (2020) , Mattern (2013) and Boudon-Millot (2012) . Cf. Schlange-Schöningen (2003) . For a concise overview of his life and career, see Hankinson (2008) . Moraux (1985) provides a representative collection of passages from the Galenic corpus that help build a picture of Galen’s experiences and opinions. On the interconnection between medicine and philosophy in Galen, see succinctly Boudon-Millot (2019) . 2 Ierodiakonou (1993) , Trapp (2017 : 31–32). 3 This amounts to around 20,000 pages of printed text. 4 Galen’s exceptional productivity was well known in antiquity, e.g. Athenaeus, The Sophists at Dinner (early third c. AD) 1.1e states that Galen of Pergamum has ‘published more works on philosophy and medicine as to surpass all his predecessors’. See Nutton (1984 : 317–318) and especially Nutton (2008 : 358–359). On Galen’s early reception, see Pietrobelli (2019) . Boudon-Millot (2017) mentions 500 treatises attributed to Galen, and Nutton (2013 : 391, n. 21) estimates that Galen’s ‘writings in Greek amount to approximately 10 per cent of all surviving Greek literature before AD 350'. 5 Lib. Prop . 15, 169.13 Boudon-Millot = XIX.45.10–11 K. 6 See also n.1, Chapter 6 . 7 Gill (2003 : 40–44). 8 Popularphilosophie (‘popular philosophy’) or Die popularphilosophisch-ethischen Schriften (the ‘popular philosophical-ethical writings’) are terms coined by Ziegler (1951 : 637, 702) with reference to Plutarch’s works on practical ethics. For Popularphilosophie specifically, Ziegler was most probably inspired by the application of the same term to works of the German Aufklärung in the second half of the eighteenth century; see Holzhey (1989) . The term praktische Seelenheilungsschriften (‘practical psychotherapeutic writings’) was also deployed by Ingenkamp (1971) for his analysis of Plutarch’s On the Control of Anger , On Talkativeness , On Curiosity , On Compliance and On Praising Oneself Inoffensively ; while ‘broadcasting ethics’ has been recently devised by Roskam and van der Stockt (2011) for the same purposes. 9 Thus, ‘popular’ meaning ‘less- or non-doctrinaire’, ‘commonsensical’, and not ‘folk’, ‘demotic’, ‘populist’ or ‘vulgar’. On the meaning of ‘popular’ in popular philosophy and ethics in the Imperial period, see Morgan (2007 : 1–5) and van Hoof (2010 : 6–7). Cf. Goulet-Cazé (2007) and Thom (2012) . For a definition and description of the independent discipline of practical ethics, see van Hoof (2014) ; cf. Schofield (2003 : 253–256) and van der Stockt (2011 : 19–21). 10 Hence, Pelling (2011 : 55–58) appositely suggested the alternative label ‘educated ethics’, which includes ‘material for the cultured, educated, sensible person to work on and exploit’ (p. 57). 11 Trapp (2014 : 45). See also the similar emphasis on the practical appeal of moral philosophy in the pseudo-Galenic work History of Philosophy 1–2, 597.1–598.16 DG = XIX.223.1–224.17 K.; [ Hist. Phil .] 4, 602.12–603.6 DG = XIX.231.1–16 K.; [ Hist. Phil .] 6, 603.14–20 DG = 232.10–18 K. 12 The Interaction Between Someone Making Public Demonstrations and Their Audience (περὶ τῆς τῶν ἐπιδεικνυμένων < πρὸς > τοὺς ἀκούοντας συνουσίας), To Orators in the Forum (πρὸς τοὺς ἀγοραίους ῥήτορας), The Interaction Between the Parties to a Dialogue (περὶ τῆς ἐν τοῖς διαλόγοις συνουσίας), The Discourse with Bacchides and Cyrus in the Villa of Menarchus (περὶ τῆς ἐν αὐλῇ Μενάρχου διατριβῆς πρὸς Βακχίδην καὶ Κῦρον). In the light of a close parallel from Avoiding Distress (ὥσπερ τῆς ἐν αὐλῇ μοναρχικῇ διατριβῆς, 11, 76.12 PX), some scholars argue that ἐν αὐλῇ Μενάρχου in the above title should be emended to ἐν αὐλῇ μονάρχου, e.g. Kotzia and Sotiroudis (2016 : 125). In that case we would be talking about private discussions on ethics taking place ‘at the imperial court’. As is clear, the emphasis in all these titles is on how a relationship or an interaction actually works or should, ideally, work. Galen’s Kroniskoi may also belong to this first group of writings on practical ethics. Although we know nothing about this work, it is most likely a literary description of erudite conversations that took place at banquets celebrating the Roman festival of Saturnalia ( pace Nutton 2021 : 123). The Saturnalia were held in honour of the god Saturn, the Roman equivalent of Greek Kronos, which helps explain why the work is given the Greek title Kroniskoi . In that sense, Galen’s Kroniskoi resembles Plutarch’s Table Talk or Athenaeus’s The Sophists at Dinner , which further validates Galen’s understanding of practical ethics as being deeply entrenched in social practice. The assumption of the generic affiliation of Galen’s Kroniskoi with the Imperial literary symposium chimes with the structure of the work itself, namely its sub-division into seven sections, in line with the division of Plutarch’s Table Talk and Athenaeus’s The Sophists at Dinner , each consisting of nine sections. 13 On Slander (περὶ τῆς διαβολῆς), Things Said in Public Against Flatterers (περὶ τῶν δημοσίᾳ ῥηθέντων κατὰ κολάκων), To What Extent the Esteem and Opinion of the Public is to be Taken into Account (μέχρι πόσου τῆς παρὰ τοῖς πολλοῖς τιμῆς καὶ δόξης φροντιστέον ἐστίν). Love of riches ( philoploutia ), another standard passion in Imperial-period disquisitions on moralia (e.g. Plutarch’s On Love of Money or Aelius Aristides’s Oration of Rome ), is also explored by Galen: at the very end of his Avoiding Distress , he refers to a work he had produced entitled On Rich People Infatuated with Money (περὶ τῶν φιλοχρημάτων πλουσίων, 18, 92.6 PX), now lost. 14 I say ‘widely’ because the essence of paideia for a pepaideumenos in this period was itself a contested question, especially in view of the tendency of professional sophists to lay greater stress on technical literary and oratorical accomplishment rather than on moral uprightness. Adrian of Tyre in Philostratus’s Lives of the Sophists or Lexiphanes in Lucian’s eponymous dialogue are representative examples of this. 15 Agreement (περὶ ὁμονοίας), Modesty (περὶ αἰδοῦς), Consolation (περὶ παραμυθίας). The work The Best Men Profit from Their Enemies (of which only two fragments survive in Arabic; see Meyerhof 1929 : 84, Lamoreaux 2016 : 122, §131) is very much reminiscent of Plutarch’s moral essay On How to Benefit from your Enemies and also fits the thematology of Galen’s popular philosophical works. Here the emphasis is on Galen’s disinterestedness and philanthropy: he does not charge his students or patients any money, nor does he yield to bribery. Rather, he ministers to the sick by supplying material goods (medicines, food) and services (nurses), and promotes the medical careers of other doctors. The rest of the titles of Galen’s ethical works bear out their inclination towards politics ( Public Pronouncements in the Presence of Pertinax , <περὶ> τῶν ἐπὶ Περτίνακος δημοσίᾳ ῥηθέντων) and philosophical theory: The Purpose of Life According to Philosophy (περὶ τοῦ κατὰ φιλοσοφίαν τέλους), Pleasure and Pain (περὶ ἡδονῆς καὶ πόνου), The Consequences of Each Chosen Purpose in Life (περὶ τῶν ἀκολούθων ἑκάστῳ τέλει βίων), Against Favorinus’s Attack on Socrates (πρὸς τὸν Φαβωρῖνον κατὰ Σωκράτους). The content of the works To Make the Punishment Fit the Crime (περὶ ἁμαρτημάτων καὶ κολάσεως ἰσότητος), The Making of Wills (περὶ διαθηκῶν ποιήσεως) and On Idleness (a title restored from the Arabic tradition, Boudon-Millot 2007: 170, n. 2) is less easy to define. The content of the work περὶ τῶν ἀναγιγνωσκόντων λάθρᾳ has been much debated. Whether we take it to mean People who Read in Secret , On Those who Plagiarise , On Those who Teach/Lecture Surreptitiously (see Boudon-Millot 2007 : 226–228) or even Solitary Readers ( Nutton 2020 : 77, with n. 15), λάθρᾳ adds an ethical dimension to the activity of the verb’s subject, which explains the inclusion of this text among Galen’s moral writings. There are more ethically-inclined works under other book categories, e.g. Whether Physiology is Useful for Moral Philosophy (εἰ ἡ φυσιολογία χρήσιμος εἰς τὴν ἠθικὴν φιλοσοφίαν, Lib. Prop . 19, 172.17–173.1 Boudon-Millot = XIX.48.4–5 K.) or The Happy, Blessed Life According to Epicurus (περὶ τῆς κατ’ Ἐπίκουρον εὐδαίμονος καὶ μακαρίου βίου, Lib. Prop . 19, 172.14–15 Boudon-Millot = XIX.48.1–2 K.). The latter is related to the work On the Epicureans , another title restored from the Arabic tradition and belonging to the works on moral philosophy ( Boudon-Millot 2007 : 170, n. 2). 16 Prop. Plac . 14, 136.21–22 PX; PHP 9.7, 588.7–27 DL = V.779.16–781.8 K. 17 The desideratum has been noted by some critics: e.g. Petit (2018 : 134–135): ‘Mais il manque une étude du Galien moraliste, spectateur impuissant et indigné des turpitudes de la société romaine.’; Lee (2014 : 55): ‘With few exceptions, little attention has been paid to Galen’s own account of moral transformation ...’; Linden (1999 : 11, n. 5): ‘It is unfortunate that Galen’s contribution to ethics, not only with regard to medicine, but also to ethical methodology, has found so little attention among scholars ...’. Others have vaunted the pervading presence of ethics in Galen’s vast corpus and its importance, e.g. Asmis (2014 : 136–138), Hankinson (1993 : 185), but have not gone into it in any detail. 18 Galen himself tells us that the Roman emperor referred to him as ‘the first among doctors and unique among philosophers’, Praen . 11, 128.27–28 N. = XIV.660.11–12 K. Elsewhere he goes so far as to say that his teacher, the Peripatetic philosopher Eudemus, knew him for his philosophical standing and considered his practice of medicine a sideline, Praen . 2, 76.27–78.2 N. = XIV.608.13–18 K. On the model of the medicus philosophus that Galen embodies, see Romano (2000 : 35–48). On Galen specifically, see Tieleman (2020) . 19 It is interesting that Caelius Aurelianus (fl. 400 AD, traditionally labelled a compiler of Soranus’s works) draws a clear distinction between mental disorders and moral passions (greed, fear, sadness, anger), demarcating them as subjects belonging to two different areas of study, e.g. Caelius Aurelianus, Acut. Morb . 3.13.109–111 (356.21–358.17 Bendz); see also Polito (2016) . The rhetorical and emotive style of Aretaeus’s On Acute and Chronic Diseases led him to circumstantially discuss social shame arising from physical disfigurement or (uncontrollable) behaviour as part of the symptomatology of the patient’s disease. However, no practical ethical components are attached to such discussions other than those serving the author’s rhetorical aims, e.g. Acut. Morb . 2.2.17–18 (21.16–26 Hude). Similarly, Rufus of Ephesus does not explore practical ethics, despite his cursory interest in the effect of a disease (e.g. melancholy) on someone’s moral state. Cf. Swain (2008) . Elsewhere, for example in his Medical Questions , the patient’s character traits play a role in the diagnosis of the disease, e.g. Quaest. Med . 1, 24.8–12 Gärtner; 8, 38.21–22 Gärtner; 13, 46.15–17 Gärtner; cf. Letts (2016) . And in other works, he refers in passing to vice and virtue in the context of his medical narratives, e.g. Sat. et Gon . 83.11–84.2 Daremberg-Ruelle. 20 Nutton (2020 : 91–92). 21 E.g. Celsus, De Med . 1.3.15–16 (34.19–25 M.), 1.5.2 (39.25–26 M.), 3.6.6–7 (111.32–112.7 M.), 3.18.18–24 (126.5–127.15 M.). The same goes for Soranus (despite the fact that he wrote a work entitled On the Soul , now lost): Gyn . 1.16 (46.95–96 Burguière, Gourevitch, and Malinas), 2.19 (31.80–96 Burguière, Gourevitch, and Malinas), 4.2 (4.59–65 Burguière, Gourevitch, and Malinas). At other times, moral qualities referred to in these authors are connected with professional conduct, e.g. Soranus, Gyn . 1.3 (6.1–8.45 Burguière, Gourevitch, and Malinas), Celsus, De Med . 7.pr.4 (301.24–302.5 M.); also in Aretaeus, Chr. Morb . 1.1.2 (36.11–13 Hude). Caelius Aurelianus, on whose theory of emotions see Horstmanshoff (1999) , can also be added to this category. 22 Coughlin (2018) . 23 Pseudo-Quintilian, The Lesser Declamations 268. 24 This is also supported by the fact that the doctor acknowledges the admirability of philosophy on the grounds that it promotes contentment with modest means ( modicis contenta est ) and the lack of desire for greater wealth ( ampliores opes non desiderat ). He must thus be referring to moral philosophy in particular. 25 E.g . De Mor . 40 Kr. 26 See Jouanna (1997) , Linden (1999 : 5–9) and Nutton (1972 : 57–58); cf. Petit (2019 : 51–55). There is still no comprehensive account of Galen’s medical deontology in its own right or its connection with practical philosophy. Research into the connection between medical ethics and practical philosophies in Graeco-Roman antiquity was noted as a desideratum by Kudlien (1970b) as early as 1970, but it has never been fully addressed since then. For Greek medical ethics Carrick (2001)is the most authoritative study. 27 The major work in this area is Gill (1998) , (2007) , (2010 : 243–329); also Hankinson (1991) and (1993) , Tieleman (2003b) , Donini (2008) , Schiefsky (2012) . See also the relevant chapters in the volume by Manuli and Vegetti (1988) . 28 Siegel (1973) considered them neurological conditions and categorised them into syndromes involving the nervous system and syndromes involving mental changes. See also Thumiger and Singer (2018 : 1–24). 29 In Affected Places Galen claims that the lesions of the rational or hegemonic/regent part of the soul provoke mental illnesses (e.g. phrenitis, lethargy, melancholic delirium), whereas the affections that strike the lower parts of the soul (i.e. the spirited and the desiderative/appetitive) cause moral aberrations, e.g. cowardice. Despite the fact that Galen occasionally argued for a natural aetiology for both mental illnesses and passions of the soul, he compartmentalised the two groups: ‘For clarity of exposition, let the functions of the rational mind (αἱ μὲν τοῦ λογιστικοῦ τῆς ψυχῆς ἐνέργειαι) be called “directive” (ἡγεμονικαὶ), and those of non-rational minds (αἱ δὲ τῶν ἀλόγων) “moral” (ἠθικαί); about the latter I do not intend to speak, or about the affections of the liver or the heart.’ ( Loc. Aff . 3.6, VIII.163.2–5 K.). Just like Galen, Plutarch too in On Superstition 165C refers to pathē specifically as illnesses ( nosēmata ) of the soul (also in De Garr . 502E, 504E-F, De Cohib. Ira 457B-C, De Curios . 515C-D, De Inv. et Od . 536E). On Galen’s passions as nosēmata psychēs , see Gill (1985 : 317), Devinant (2018 : 201–204) and Singer (2021 : 156, with n. 3), who uses the term ‘medical psychic impairments’ to better distinguish them from emotions. Note Maximus of Tyre’s oration entitled Which Diseases (nosēmata) are Harsher, Those of the Body or Those of the Soul? ( Oration 7, ed. Trapp 1994 ) and Plutarch’s (incomplete) essay Whether the Passions (pathē) of the Soul are Worse than Those of the Body ( Mor . 500B-502A), with both works exploring moral passions such as anger, grief, pleasure, hatred, envy etc. (rather than mental dysfunctions) as sicknesses of the soul. The well-known analogy between body and soul and thus medical and philosophical therapy, which is pervasive in the Hellenistic and Roman periods, also theorises passions as diseases of the soul: ‘Philosophy heals human diseases, diseases produced by false beliefs. Its arguments are to the soul as the doctor’s remedies are to the body. They can heal, and they are to be evaluated in terms of their power to heal. As the medical art makes progress on behalf of the suffering body, so philosophy for the soul in distress’, Nussbaum (1994 : 14). See also Edelstein (1967 : 362–366), Pigeaud (1981) , García Ballester (1988) , Luchner (2004 : 99–170) and succinctly Gill (2013 : 343–348). Edelstein’s (1967 : 350) view is also worth quoting: ‘The true contribution of medicine to philosophy, I venture to suggest, lies in the fact that philosophers found in medical treatment and in the physician’s task a simile of their own endeavor. The healing of diseases, as well as the preservation of health, provided an analogy which served to emphasize the validity of certain significant ethical concepts and thus helped to establish the truth of philosophy; therein consisted the most fruitful relationship between ancient medicine and ancient philosophy’. 30 Harris (2013 : 9); cf. van der Eijk (2013) . One such example of mingling is, for instance, when Galen refers, as he often does, to the emotional manifestations of specific clinical conditions, e.g. fear and despondency ( phobos and dysthymia ), accompanying the melancholic condition. 31 E.g. Becchi (2012) , Singer (2013 : 4–41), Kaufman (2017) , Singer (2018) , Singer (2019b) , Lee (2020 : 49–102). See also the beginning of Chapter 6 . 32 The first few paragraphs of Chapters 4 – 8 explain in more detail how this book advances previous research and plugs gaps in scholarly literature for each text under examination. 33 E.g. Schmitz (2007 : 172–175) with further reading. 34 This view refers to Galen’s attachment to philosophy in general, though as the scholarly citations below show, ethics in particular is also involved: Nutton (1985 : 28–29): ‘Galen’s own justification of medicine is a desperate attempt to raise it to the level and status of philosophy, an art fully worthy of the truly free man. His convoluted argument links a doctor’s detailed knowledge of the internal organs of the body with the possession of all the moral virtues, and turns the doctor into a super-saint’. Galen belongs to a group of writers, Nutton goes on, who ‘are all using the same language and arguments in an attempt to suggest that their own individual speciality is somehow on a higher social and intellectual plane. They endeavour to replace mundane reality by a high ideal.’ See also Nutton (1972 : 57–58). Cf. Pleket (1995 : 33): ‘That a thorough philosophical training may well have enabled the physician to communicate with his patients better and perhaps even to cure them more successfully (or at least to make them believe it) is true enough. But I do feel that it was also and above all a mechanism for acquiring social respectability in a society in which rhetors, sophists and rhetorically educated elite-members increasingly dominated urban politics. The more philosopher, the less dirty hands and the more prestige.’ See also Grant (2000 : 9): ‘Galen’s emphasis on philosophy as a key to becoming a good doctor may be his attempt to link the honoured with the maligned disciplines. It certainly gave him the prestige to mingle with the upper echelons of society, if not as an equal, then certainly as someone to be admired.’; cf. Mattern (2008a : 9), Mattern (2013 : 113–114). © Sophia Xenophontos 2024. This work is in copyright. It is subject to statutory exceptions and to the provisions of relevant licensing agreements; with the exception of the Creative Commons version the link for which is provided below, no reproduction of any part of this work may take place without the written permission of Cambridge University Press. An online version of this work is published at doi.org/ 10.1017/9781009247795 under a Creative Commons Open Access license CC-BY-NC-ND 4.0 which permits re-use, distribution and reproduction in any medium for non-commercial purposes providing appropriate c redit to the original work is given. You may not distribute derivative works without permission. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-nd/4.0 All versions of this work may contain content reproduced under license from third parties. Permission to reproduce this third-party content must be obtained from these third-parties directly. Bookshelf ID: NBK611999 DOI: 10.1017/9781009247795.001 Contents < Prev Next > Share Views PubReader Print View Cite this Page Xenophontos S. Medicine and Practical Ethics in Galen [Internet]. London (UK): Cambridge University Press; 2023 Dec. 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