van der Eijk: Mente e cérebro na medicina antiga (introdução)

Recent research into the principles and methods of doxography (the description of the doxai, the characteristic doctrines of authorities in a certain subject) has revealed that the question ‘What is the leading principle in man and where is it located?’ more or less assumed a life of its own in late antiquity, separate from the scientific context from which it originated. It became a favourite subject for practising argumentation techniques (comparable to questions such as ‘Is an embryo a living being?’), [1] whereby contrasting views were taken in an artificial debate (sometimes even views that, although theoretically possible, have, as far as we know, never actually been supported), which were subsequently attributed to authorities in the field, and which served as exercise material for finding and using arguments both for and against. Such ‘dialectic’ staging of a debate bears little relation to a historically faithful rendition of a debate that actually took place in the past.

It is most probable that Caelius Aurelianus’ summary of views as quoted above is part of such a doxographical tradition, and therefore highly schematised. In his presentation, the views of those to whom he refers - without mentioning their names [2] — imply a number of presuppositions regarding empirical evidence and theoretical concepts in respect of which it is questionable whether the authorities concerned actually held them. A question like ‘What is the leading principle of the soul and where is it located?’ presupposes that there is such a thing as a leading ‘part’ or principle in the soul and that it can be located somewhere. The debate to which Caelius [122] Aurelianus is referring concerns the so-called hegemonikon or regale. This term is probably of Stoic origin (c. 300 bce) and refers to the ‘leading’ principle in the soul (commonly indicated as nous or intellectus, which is usually translated as ‘thought’ or ‘intellect’). The use of this term implies the possibility of grading various psychic parts or faculties, some of which are subordinate to others, and presupposes an anatomical and physiological relationship underlying such a hierarchy. On the one hand such a presentation presupposes a rather elaborate psychological theory, free from the difficulties and obscurities that, for instance, Aristotle   points out when he discusses the psychological views of his predecessors in the first book of his On the Soul (De anima). It will be clear that a presentation such as that by Caelius Aurelianus, in which all doctors and philosophers are called to the fore to express their views on the matter, puts opinions in their mouths that many of them (probably) never phrased in these terms. On the other hand, such a presentation does not do justice to thinkers such as Aristotle and some authors of the Hippocratic Corpus, as it often obscures the subtle differences in meaning between the various terms used for psychic faculties by these thinkers. We will see below that as early as the fifth and fourth centuries bce, doctors and philosophers carefully differentiated between cognitive faculties such as ‘practical’, ‘theoretical’, and ‘productive thinking’; ‘insight’; ‘understanding’; ‘opinion’; and ‘judgement’. [3] Indeed, the possibility of location was a matter of dispute too. Thus Aristotle was credited in late antiquity with the view that ‘the soul’, or at least its leading principle (the arche), is seated in the heart. We will see that this is a misrepresentation of Aristotle’s views, which, strictly speaking, leave no room for location of the highest psychic faculty, the nous. Similarly, the author of the Hippocratic work On Regimen (at the start of the fourth century bce) presupposes a view of the soul that does not specify where exactly it is located in the body; he even appears to assume that the location may vary. In short, this doxographic distortion attributes to doctors and philosophers answers to questions which some of them would not even be able or willing to answer as a matter of principle.

Finally, Caelius Aurelianus upholds a long tradition of contempt for the so-called phusiologia. This tradition dates back to the author of the Hippocratic writing On Ancient Medicine (c. 400 bce). He was opposed to some of his colleagues’ tendency to build their medical practice on general and theoretical principles or ‘postulates’ (hupotheseis) derived from [123] natural philosophy, such as the so-called four primary qualities hot, cold, dry and wet. By contrast, he adopted a predominantly empirical approach to medicine, which in his view was tantamount to dietetics, the theory of healthy living. His approach was based on insights into the wholesome effects of food, insights that had been passed down from generation to generation and refined by experimentation. He even went so far as to claim that in reality physics does not form the basis for medicine, but medicine for physics.

The question of to what extent a doctor should be concerned with, or even build on, principles derived from physics (or metaphysics) remained a matter of dispute throughout antiquity. What made the problem even more urgent was that in many areas of controversy, such as that on the location of the mind, it remained unclear to what extent these could be resolved on empirical grounds. The doctor’s desire to build views concerning the correct diagnosis and treatment of psychosomatic disorders such as mania, epilepsy, lethargy, melancholia and phrenitis on a presupposition about the location of the psychic faculties affected, which could not be proved empirically, differed according to his willingness to accept such principles, which were sometimes complimentarily, sometimes condescendingly labelled ‘philosophical’. [4] This group of doctors with a profoundly philosophical interest included, for instance, Diodes of Carystus (fourth century bce) and the author of the Hippocratic work On the Sacred Disease (end fifth century bce). They corresponded to an ideal proclaimed first by Aristotle and later by Galen  , namely that of the civilised’ or ‘distinguished’ physician, who is both a competent doctor and a philosopher skilled in physics, logic, and rhetoric. [5] Caelius Aurelianus’ derogatory remark shows that this ideal was by no means beyond dispute. Yet in this dispute, too, the variety of views on the matter was much wider than his general characterisation suggests. It is therefore highly likely that Caelius Aurelianus’ presentation intends to exaggerate the differences in opinion between the doctors mentioned, in order to make his own view stand out more clearly and simply against the background of confusion generated by others.

These introductory observations may suffice to provide an outline of the debate on the seat of the mind, which was the subject of fierce dispute [124] throughout classical antiquity (and remained so until the nineteenth century), and to which no definitive answer was found. In so far as antiquity is concerned, there were at least three causes for this: the reasons for asking the question (and the desire to answer it) differed depending on whether one’s purposes were medical, philosophical or purely rhetorical; the status of the arguments for or against a certain answer (such as the evidential value of medical experiments) was subject to fluctuation; and the question itself posed numerous other problems related to the (to this day) disputed area of philosophical psychology or ‘philosophy of the mind’, such as the question of the relationship between body and soul, or of the difference between the various ‘psychic’ faculties, and so on. When following the debate from its inception until late antiquity, one gets the impression that the differences manifest themselves precisely in these three areas. Whereas the doctors of the Hippocratic Corpus were mainly interested in the question of the location of the mind in so far as they felt a need for a treatment of psychological disorders based on a theory of nature, later the situation changed and medical-physiological data were no more than one of the possible (but by no means decisive) factors to build arguments for one of the positions taken on.