Mental illness in ancient Rome

Roman doctors and philosophers classified severe anxiety as a diagnosable medical condition. Stoicists, which were followers of a Roman philosophy centered around using self-control to overcome negative emotions, theorized methods of handling anxiety.[2][3] Their methods resembled Cognitive behavioral therapy, which is a modern therapy for anxiety disorders.[4][5] Stoicists would practice a technique known as negative visualization,[6] which involved considering the worst possible outcome of an action or event, in order to prepare oneself for the consequences of it.[7][8] They would also mentally rehearse how they would respond to such problems, and try to find a way to change negative situations into positive ones. The purpose of such practices was to train the practitioner to have little fear, and eventually allow them to remain calm in difficult situations.[9] Seneca, a Roman stoic philosopher believed that to cure anxiety, one must focus on the present moment.[10] Romans also used amulets to cope with anxiety and provide reassurance.

Galen, an ancient Greek medical doctor, had many patients with symptoms resembling Generalized Anxiety Disorder or Major Depressive Disorder. Such as sweating, indigestion, palpitations, dizziness, fever, weight loss, insomnia, changing skin color, low heartbeat, and an irregular heartbeat. Sufferers from this disease are described as having a progression of anxiety and sadness. It was believed that such anxiety could result in death. Galen states that this syndrome emerges from an emotion he calls lypē. The word lypē is often translated as "distress" or "grief." Cicero, a Roman orator distinguished between Anxietas, sollicitudo, and angor.[11] Anxietas, in his view, was worry about future events. Angor, according to Cicero, was a outburst of emotion.[10][12]

Plutarch, an ancient Greek philosopher and historian, describes an ancient Roman man possibly suffering from scrupulosity, which is guilt or anxiety over religious subjects. It is commonly associated with Obsessive-compulsive disorder, and Obsessive-compulsive personality disorder.[13][14] Only OCD is recognized as an anxiety disorder.[15] This man is described as "turning pale under his crown of flowers," praying with a "faltering voice," and scattering "incense with trembling hands."[16][17]

Aretaeus of Cappadocia, the Greek physician who studied patients presumed to have bipolar disorder.

Mood disorders are frequently described in ancient Roman medical literature. Roman doctors and physicians identified two kinds of mood disorder, melancholia and mania. Melancholia was characterized by depressive episodes. Celsus, a Roman doctor, wrote of a depressive disease he theorized to be caused by excess amounts of black bile. He believed that to treat this disease, bloodletting should be used. If bloodletting was not an option, hellebore should be used to make the sufferer vomit. In addition, patients should be provided with exercise, black hellebore, intellectual activities, and be restricted from wine. Aretaeus of Cappadocia, a Greek physician who lived in the Roman province of Cappadocia, describes melancholic patients who experience episodes of depression and suicidal ideation. Alongside episodes of "impure dreams" where they have "irresistible desires." In this state they are easily angered by criticism, and they become "wholly mad." Aretaeus also describes sufferers of this disease experiencing hallucinations and delusions. This disorder resembles bipolar disorder, which is defined by episodes of mania and depression.[18] It was thought to be caused by too much black and yellow bile.[19][20] Galen wrote that phobias and dysthymia, another depressive disorder, could cause melancholia. Alcohol abuse, hypersexuality, aggression, and extreme emotions were thought to increase the risk of developing this disorder. It is unclear if ancient doctors thought of the mania and depression present in these people as separate conditions, or one singular condition.[21][22][23] Lithium is a chemical element used to treat bipolar disorder.[24][25] This element can be found in alkaline springs near Ephesus, an ancient city in Turkey. The Roman doctor Soranus of Ephesus noticed that the condition of sufferers of this disease would improve after they drank from these springs.[26][27] More common treatments included applying cool materials to a patient's head.

Seasonal affective disorder is a medical condition in which the sufferer experiences mood changes alongside seasonal changes.[28] One treatment for this disorder is light therapy.[29] The Romans know that exposure to light could serve as a treatment for those afflicted with certain conditions. However, they did not know why.[30] Cicero experienced several depressive episodes over the course of his lifetime. During these periods he kept a journal documenting his days, and his sadness. This has been found to alleviate depression and sadness, and it is a form of therapy still used today.[31] Magical objects were used to treat anger. Users would offload their feelings onto these objects.[32]

Romans with intellectual disabilities had limited rights. They may have been capable of functioning in normal society by helping with menial labor.[33][34] However, they also were considered property of their father or were kept as slaves.[35] The intellectually disabled were considered to be on the same level as children, and they could not marry, hold office, or raise children. These people were often looked down upon and disrespected.[36] Many of them were killed early in the childhood, and then dumped into the Tiber in order to avoid them burdening society.[37] However, they were exempt from their crimes under Roman law.[38][39]

Speech disorders were known in ancient Rome as tarditas ingenii or lingua impromptus.[38] They were thought of as a sign of unintelligence.[40] Emperor Claudius had such a condition, which was likely either cerebral palsy or Tourette syndrome.[41][42] His mother and the rest of Roman society thought of him as mentally deficient, less of a man, and "unfinished by nature."[43] Stuttering is a speech disorder characterized by involuntary repetition or prolongations of sounds and pauses in speech. It was thought to be caused by an excessively moist tongue, or an excessively dry tongue. Galen recommended wrapping the tongue with a cloth soaked in lettuce juice to treat a stutter.[44][45] Another treatment for a speech disorder was tongue massages and gargling.[46] A young Roman boy by the name of Bradua was described as being unable to read, and Livy speaks about Roman adults who could not achieve literacy on par with young children. It is possible these people were dyslexic. Dyslexic Romans could achieve high status in Roman society; for example, Bradua became a consul. Treatments for intellectual disabilities included nutritional diets combined with exercise.[38] Roman emperor Augustus was described by Suetonius as having difficulty learning to read or write and having trouble remembering his speeches despite his intelligence, possibly indicating that Augustus had dyslexia. However, Suetonius may have been trying to highlight imperfections in Augustus to make Hadrian seem like the superior emperor. It is also possible that Augustsus had poor education, or was writing with unconventional orthography.[47]

Bust of Asclepiades, a physician who discussed treatments for a mental disorder which may be schizophrenia.

Ancient Roman doctors described a condition they termed phrenitis or mania. It was theorized that this condition was caused by high amounts of bile due to fever, which would heat the blood, resulting in the onset of an illness.[48] Ancient doctors noticed that this disorder appeared most frequently in young and middle-aged men, and that it appeared rarely in children, women, or older adults.[49] Modern scholars disagree on the nature of this condition. It is possible that it is schizophrenia. However, others believe that there are no mentions of schizophrenia in ancient literature - that schizophrenia, in its modern form, did not exist in ancient times.[31][50]

Celsus, a Roman physician, described a mental illness which induced episodes of delirium and incoherent speech. Celsus also wrote about a chronic condition which resulted in "entertaining vain images" and caused the mind to be "at the mercy of such imaginings." He distinguished between differing types of this disease. According to Celsus, some were saddened, some became "hilarious," some began to "rave in words," some remained composed, others became "rebellious and violent" Various types of violence are described. Some "do harm by impulse," while others appear to remain sane, yet still commit elaborate acts of violence. Celsus may be describing delusions caused by psychosis, which are false beliefs unable to be changed by evidence to the contrary.[51] He also may be describing a depressive disorder.[52] Celsus mentions certain delusions. He states that one patient believed they could interact with Ajax or Orestes. Arataeus writes about mentally ill people suffering from hallucinations, disorganized speech, delusions, social withdrawal, poor performance at work, and catatonia. He believed that these people are suffering from mania, however they may have been schizophrenic.[53]

A variety of treatments were used. Doctors expressed disapproval of patients who excessively laughed. Cymbals were used to play music, which was thought to reduce melancholic thoughts. Philosophers were used to alleviate the fear and worry the patient experiences. Doctors recommended that patients should be treated through conversation. Servants were supposed to engage in dialogue with the patient. However, they should not agree with everything they say, as this might feed into the delusions. They were also not supposed to disagree with everything the person said, as this might enrage them. The patients were also provided a variety of intellectual activities to keep them engaged. These activities would have been tailored to each patient.[53]

It was common to treat these people by confining them to a dark room. Celsus believed that this form of therapy's usefulness varied from person to person. Some will be frightened by the darkness, other will be calmed. He recommended that "strong" patients should be kept in a bright room, and "weak" ones should be kept in a dim room. Celsus also recommended torture. Violent sufferers were restrained using chains and flogging. Deprivation of light, immersion into cold water, torturous exercise, food depravation were all used. Patients were also supposed to only be left with people they were familiar with, and frequently travel and move. They were forced to pay attention and memorize this torture, thus preventing patients from acting out through fear. This treatment was dismissed by two physicians Asclepiades of Bithynia and Soranus of Ephesus as inhumane. They believed that instead, patients should kept in a moderately light room located on the ground floor, eat a simple diet, and have regular exercise. They also recommended that soft fabrics, wool, or servant's hands should be used instead of chains to restrain them.[53]

Bloodletting was another contentious topic. Asclepiades believed it to be equivalent to murder. Celsus disagreed, stating that if a patient was "strong," it must be administered if they are experiencing an extreme episode of the condition. He also recommended that one day after the bloodletting the head should be shaved and cleaned with water. Herbs such as verbena would be boiled in the water. Another procedure consisted of cleaning the head, shaving the head, cleaning it again, then pouring rose oil over it. Concurrent to this, rue pounded with vinegar would be poured over the nose. If the patient is considered "weak" then thyme, or a similar substance, would be applied to rose oil which would then be rubbed over the head. Bitter pellitory herbs would also be applied to the sufferer's head.[53]

People with this condition also had trouble sleeping and eating. To treat this, they were placed on couches near food. Poppy, Hyoscyamus, saffron ointment, mandrake apples, cardamomum balsam, the sound of falling water, sycamine tears, and mulberry were all though to aid in sleep. Asclepiades believed these treatments to be ineffective, and that they caused lethargy. Leeches, venesection, and vomiting were also common treatments. An orchid known as white hellebore was used to induce vomit. Doctors would give these patients gruel and mead to eat and drink. Three cups of gruel were given twice a day in winter and three times in summer.[53][54]

Aelius Aristedes, a Greek writer who may have been a hypochondriac.[55][56][57]

Juvenal, a Roman poet, complained about the noise of the city making it difficult to sleep, causing insomnia.[58] Pervasive insomnia throughout ancient Rome resulted in numerous deaths.[59] The Roman name for sleep deprivation was tormentum vigilae, or "waking torture."[60] They used sleep deprivation to torture criminals and prisoners.[61] Sleepwalking was associated with evil spirits.[62] Roman men could often develop hypochondriasis due to their tendency to discuss and pay attention to medical matters.[63] The ancient Romans did not conceive of personality disorders or substance-related disorders. They did not believe that these defects were conditions worth treating. Except for Alcohol abuse, which was recognized by Augustine and Pliny the Elder as a problematic condition. Eating disorders were considered to be problematic by the Romans. Galen defines two conditions, lichneia, which was a craving for sweets, and gastrimargia, which is bulimia nervosa.[38] A possible ancient example of anorexia nervosa, an eating disorder characterized by extremely limited consumption of food, involved a Roman saint named Blaesilla. Blaesilla was a disciple of Jerome. She practiced fasting, eventually succumbing to her hunger and dying at the age of 20.[64] Post-traumatic stress disorder and acute stress disorder, disorders characterized by stress and fear over reminders of a certain traumatic event, were present throughout ancient Rome.[65][66][67] Ancient writers mention people who faked mental illnesses to escape responsibilities. In the modern day, deliberately feigning a mental illness for attention is known as factitious disorder imposed on self. If done for financial or personal gain, it is known as malingering. If done with a motive on others, it is known as Factitious disorder imposed on another.[68][69][70]

Disabilities were thought to have been caused by a divine punishment.[71] Demons and evil spirits were considered to be an explanation for some mental illnesses.[72] It was also believed that mental illnesses could be developed due to natural or biological causes. The dominant theory in ancient Rome was humorism, which is the idea that each person had a group of four humors. If they were balanced then the individual would develop illnesses, including mental ones. The pulse and heartbeat of the afflicted were also used to diagnose.[39] Galen believed that negative emotions imbalanced the mind, causing disease. He believed that these emotions caused blood to retreat to "the depths of the body." Resulting in many negative symptoms and diseases such as melancholia and depression.[23] It was believed that seasons could affect the illnesses. Changes in weather were thought to stir up the humors.[73]

The Romans noticed that diseases and conditions, such as epilepsy, could be inherited. Roman doctors also distinguished between delirium, which is extreme confusion, and psychosis, which confusion between what is and is not real.[74][75] They also differentiated between people with mental illness, and those at risk of mental illness. Ancient doctors categorized some people into a "half-mad" category, which meant symptoms only emerged while drunk or stressed.[52] Popular medications included beaver testicles, weasels, smoked camel brains, tickling patients with their head near a fire, and limb bindings were used to treat epilepsy.