Helen King: saúde na Antiguidade

In Plato’s Gorgias, Socrates refers to a traditional skolion, or drinking-song, in which health is described as the greatest blessing for humankind (451e). This much-quoted song, attributed to Simonides or Epicharmos and thus going back to the fifth or even sixth century BC, says:

To be healthy is best for mortal man,
second is to be of beautiful appearance,
third is to be wealthy without trickery,
and fourth to be young with one’s friends.
(Simonides fr. 651 PMG)

Hygieia, the female personification of Good Health, was often shown standing beside her seated father, the healing god Asklepios. In the well-known hymn to Hygieia – from which the title of Emma Stafford’s chapter (Ch. 6) for this volume is taken, and which is also discussed by John Wilkins (in Ch. 7) – the fourth-century BC poet Ariphron claims that without health ‘no one is happy’ (Athenaios 15.701f–702b) or, in a different translation, ‘no one prospers’. Michael Compton (2002: 324–6) has argued that, in the cult of Asklepios, Hygieia provided a focus for healthy worshippers; in the words of the Orphic hymn to her, the goddess is ‘sole mistress and queen of all’ who is called upon to ‘keep away the accursed distress of harsh disease’ (Athanassakis 1977: 90; Compton 2002: 319). Stafford’s chapter here explores the changing position of Hygieia in ancient Greek cult, and argues that her worship tells us much about attitudes to health in Greece and also in Rome.

Another fragment of Simonides also suggests that health should be placed before other blessings: ‘there is no pleasure in beautiful wisdom if a man does not have holy health’ (fr. 604 PMG). The relative importance of the ‘good things’ was something that was discussed in antiquity; in Against the Ethicists, 48–66, the second-century AD writer Sextus Empiricus summarised the different viewpoints taken. For philosophers of the Academic or Peripatetic persuasion, health did not hold the top position (Against the Ethicists, 59); he cited the Academic Krantor, a philosopher of around 300 BC, for whom it was beaten into second place by virtue or courage (andreia). But for Ariphron, Likymnios and Simonides, as well as for ‘ordinary folk’, health was seen as the prime good. Also writing in the second century AD, Lucian described how he accidentally wished his patron ‘Health to you’, when correct protocol for the morning salutation required ‘Joy to you’ (De lapsu 1). In the course of a discussion of the different greetings possible, he gives what he claims are historical examples of each. Thus, for example, the Pythagoreans preferred ‘Health to you’ (De lapsu 5), and it was with this greeting that Epicurus often began letters to his dearest friends; it is also very common in tragedy and Old Comedy (De lapsu 5–6). Lucian cites the skolion and also the Ariphron hymn, the latter being described as ‘that most familiar piece of all which everybody quotes’ (De lapsu 6); all the blessings of the world are worth nothing without health (De lapsu 11).

So what is health? For the social sciences, it has been argued that the rise of health to the top of the research agenda is a direct result of its increased importance as a value for us (Pierret 1993) and that this in turn only became possible because of improvements in medical knowledge from the 1940s onwards (Breslow 2000: 40). Within Classics, medicine in the ancient world is now an established field of study; however, the essays in this volume, many based on papers given at a conference organised by Karen Stears at the University of Exeter in September 1994, try to shift the focus of study on to health, looking not only at ancient beliefs about health but also at the health status of the peoples of Graeco-Roman antiquity. The project combines archaeological studies of material remains with work based on literary evidence and includes two very individual accounts of the impact of the ancient world on the health of people today through hospital architecture and through drama therapy. Our society operates with two competing definitions of health.

According to the biomedical definition, health is the absence of disease. This idea of a simple polarity between hygieia (health) and nosos (disease) was one familiar in the early Roman Empire. Plutarch wrote one of several works on good health surviving from the ancient world (Advice on Keeping Well; cf. Corvisier 2001), a treatise in which he argues for moderation in regimen, and particularly in diet, in order to preserve health, and suggests that knowledge of one’s healthy self is essential so that the warning signs of imminent disease can be recognised (Mor. 127d, 129a, 136e–f ). Elsewhere, when explaining the nature of boulimos (ox-hunger), Plutarch notes that

Since any kind of starvation, and particularly boulimos, resembles a disease, inasmuch as it occurs when the body has been affected unnaturally, people quite reasonably contrast it (with the normal state), as they do want with wealth, and disease with health. (Table Talk 6.8, Mor. 694b)

The construction of disease/health as an opposition akin to want/wealth is, however, not entirely straightforward. It is much easier to talk about disease than health; readers of this volume may at times feel that they are learning more about ‘disease in antiquity’ than about ‘health in antiquity’. Disease comes in many forms, which can be classified: one part of medicine is to create this classification. Disease is an addition; it is something one ‘has’. In this sense, it is more like wealth than want; it is possession rather than lack. To bring in yet another opposition, male/female is often presented as possession (of the phallus) against absence. ‘Female’ then becomes the unmarked term, which lives in the shadow of the marked term. In many ways, health lives in the shadow of disease, something that many of us have experienced; it is sometimes only when you are ill that you realise what ‘feeling well’ was like. It is relevant here that, when the sociologist Janine Pierret conducted interviews in France and asked people to tell her what health meant to them, ‘it induced talk about illness’ (Pierret 1993: 14).

The other understanding of health is a social one (Ruzek et al. 1997: 4), seeing it as positive, rather than negative, and is based on the World Health Organisation definition offered in 1946: ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ (cited Gordon 1976: 42; Polunin 1977: 87–8). This has been widely discussed, and is mentioned by several of the contributors to this book; Roberts et al. cite a variation on it which asserts that health is ‘more than mere survival – it is living usefully despite the various diseases and stresses which challenge all of us’. Praised for its attempt ‘to place health in the broadest human context’ (Callahan 1982: 83), the WHO definition has also been rejected as ‘so comprehensive that it equates health with happiness and thus spoils its good intents’ (Nordenfelt 1993: 282); although, of course, the equation of health and happiness would not have been seen as a problem by Ariphron. When discussing Krantor’s views, Sextus Empiricus suggests that most Greeks think ‘It is not possible for happiness to exist when bedridden and sick’ (Against the Ethicists, 57, trans. Bett 1997: 12), although Plutarch considered that it was perfectly possible to be a philosopher, general or king while being weak or sickly (Mor. 126c). Unease has been expressed by modern commentators at the inclusion of ‘well-being’ in the WHO definition, as this is seen as something going beyond the state of the body, and into areas over which doctors have no control. The inclusion of social factors underlined that ‘health’ was being extended beyond the domain of medicine and into politics (Callahan 1982: 81), with the roles of housing, education and environment being recognised. Those resisting this move protested that ‘Medicine can save some lives; it cannot save the life of society’ (Callahan 1982: 84). The recent move from health to ‘wellness’, championed by institutions such as the California Wellness Foundation (Jamner and Stokols 2000), has led to the much-derided WHO definition coming back to prominence (Breslow 2000: 39). In some circles, health has been redefined according to the number of ADLs – activities of daily living, such as the ability to eat, or to go to the toilet unaided – which an individual can manage. In traditional societies, however, well-being has been defined not in terms of the individual but rather according to the relationships which that individual maintains with other people, deities or spirits; as Dominic Montserrat puts it in Chapter 14 on the healing cult of SS Cyrus and John in late antiquity, health is an issue ‘of religious, cultural and political significance, going far beyond the concerns of the individual afflicted body’. This does not seem very distant from the WHO definition; nor does John Wilkins’s point that the goddess Hygieia ‘is associated with wealth, children and power’ (p. 138, this volume). Indeed, women’s health care activists today also stress that health is ‘embedded in communities, not just in women’s individual bodies’ (Ruzek et al. 1997: 13).

While not going as far as ADLs, Galen comments on the use of ‘health’ in his own day:

I see all men using the nouns hygieia and nosos thus . . . For they consider the person in whom no activity of any part is impaired ‘to be healthy’, but someone in whom one of them is impaired ‘to be sick’. (On the Therapeutic Method 1.5.4; trans.
Hankinson 1991: 22)