van der Eijk: On the Sacred Disease (comments)

[…] this work has long been read as the paradigm of Greek fifth-century rationalism. And it is certainly true that this author, in claiming that epilepsy ‘has a nature’, is doing something very similar to what the Presocratics did in inquiring into the ‘nature’ (phusis) of things, namely their origin, source of growth and identifying structure — be they earthquakes and solar eclipses, or bodily processes and changes, illnesses, conditions, affections, symptoms, or substances like foods, drinks, drugs and poisons and the effects they produced on the bodies of human beings. And just like Ionian philosophers such as Anaximenes and Anaxagoras in their explanations of earthquakes, solar eclipses, thunderstorms and other marvellous phenomena, he produces a ‘natural’ explanation for a phenomenon — in his case ‘the so-called sacred disease’, epilepsy — that used to be seen as the manifestation of immediate divine agency. Epilepsy, the author argues, like all other diseases (and, one may [20] add, like all other phenomena), has its own ‘nature’, its peculiar determined, normal, stable and self-contained identity. Knowledge of this identity, and of the regularity that results from this, will allow one to recognise and understand individual instances of the phenomenon, to predict its future occurrence and bymedical intervention influence it or even prevent it from happening or spreading. And in making this claim, the author polemicises against people whom he calls ‘magicians, quacks, charlatans’, who regard the disease as a form of whimsical, unpredictable divine intervention or even demonic possession and whose therapeutic practice is determined by magical beliefs and procedures. He describes the development ofthe disease from its earliest, prenatal and indeed ancestral stages; he identifies the brain as the seat of consciousness and as the primary organ affected by the disease; he discusses a whole range of additional factors, both internal and external, that set the disease in motion or influence its actual development; and he gives a vivid account of the various stages of an epileptic seizure, relating each of the symptoms to a particular underlying physiological cause.

Yet for all the emphasis on the naturalness and ‘rationality’ of his approach, we shall see in chapter i that the author rules out neither the divinity of the diseases nor the possibility of divine intervention as such. He is distinguishing between an appropriate appeal to the gods for purification from the ‘pollution’ (miasma) of moral transgressions (hamartemata) that has disturbed the relationship between man and the gods, and an inappropriate appeal to the gods for the purification of the alleged pollution of the ‘so-called sacred disease’. This is inappropriate, he says, for diseases are not sent by a god — to say so would be blasphemous, he insists — they are natural phenomena which can be cured by natural means, and they do not constitute a pollution in the religious sense. The text has often been read as if the author ruled out divine ‘intervention’ as such. But in fact, there is no evidence that he does — indeed, he does not even rule out that gods may cure diseases, if approached in the proper way and on the basis of appropriate premises.

Such negative readings of the text attributing to the author the ruling out of all forms of divine intervention have presumably been inspired by a wishful belief among interpreters to ‘rationalise’ or ‘secularise’ Hippocratic medicine — a belief possibly inspired by the desire to see Hippocratic medicine as the forerunner of modern biomedicine, and which can be paralleled with interpretative tendencies to ‘demythologise’ philosophers such as Parmenides, Pythagoras and Empedocles to make them fit our concept of ‘philosophy’ more comfortably. Yet recently, there has been a renewed appreciation of the ‘mythical’ or ‘religious’ aspects of early Greek thought, [21] and a readiness to take documents such as the Dervenyi papyrus, the introduction of Parmenides’ poem and the Purifications of Empedocles more seriously. Similar ‘paradigm’ shifts have taken place in the study of Hippocratic medicine, and there is now a much greater willingness among interpreters to accept the religious and ‘rational’ elements as coexistent and — at least in their authors’ conception — compatible. The question is not so much to disengage from their mythical context those elements which we, or some of us, regard as philosophically interesting from a contemporary perspective, but rather to try to see how those elements fit into that context. Within this approach, the author of On the Sacred Disease can be regarded as an exponent of a modified or ‘purified’ position on traditional religious beliefs without abandoning those beliefs altogether and, as such, he can be said to have contributed also to the development of Greek religious or theological thought; for his arguments closely resemble those found in Plato’s ‘outlines of theology’ in the second book of the Republic, or, as I said above, Aristotle’s arguments against the traditional belief that dreams are sent by the gods in his On Divination in Sleep.

One further, paradoxical aspect of On the Sacred Disease and its alleged ‘rationality’ is worth mentioning here. On the one hand, it is probably the best known of all the Hippocratic writings after the Oath, and its author (who is widely agreed to be also the author of Airs, Waters, Places) has often been regarded as one of the most plausible candidates for being identical with the historical Hippocrates. On the other hand, this is a fairly recent development, which stands in marked contrast to the rather marginal position the treatise occupied in ancient perceptions of Hippocrates. It hardly figures in ancient lists of Hippocratic writings, and it is particularly striking for its almost complete absence from Galen’s references to the Hippocratic Corpus. This is all the more remarkable considering that it is by far the most suitable piece ofevidence for Galen’s claim that Hippocrates held an encephalocentric view of the mind; there is even a suggestion that Galen may have regarded the treatise as spurious. This indicates the changeability of assessments of a treatise’s importance and representativeness, and hence the danger of using ancient evaluations as evidence in the so-called ‘Hippocratic question’. (p. 19-21)