Kathleen M. Pike, PhD

Mentally Ill in Ancient Rome

In the 1953 romantic comedy, Roman Holiday, Audrey Hepburn and Gregory Peck fall crazy in love with each other and with Rome. They take us on a magical escapade from Trevi Fountain to the Mouth of Truth and the Coliseum. But you don’t have to be a disaffected princess to be awed by Rome. Even with the oppressive heat this week, our family vacation in Rome has been an adventure of learning about key stones, marveling at the Sistine Chapel, and enjoying too much pasta and gelato.

History is everywhere in Rome. By the 3rd century of the Common Era, the Romans already knew how to build aqueducts to transport water to over a million citizens. They achieved engineering and architectural masterpieces with structures like the Pantheon, which still contains the largest unreinforced concrete dome in the world. And gladiators entertained more than 50,000 spectators at a time in the Coliseum.

So what did Ancient Rome know and do when it came to mental illness?

1. Phrenetis, mania and melancholy. Physician Caelius Aurelianus is credited with providing one of the earliest texts on mental illness in Ancient Rome. Translating the work, On Acute and Chronic Diseases, written by Soranus of Ephesus, he described three kinds of madness: phrenetis, mania and melancholy. Phrenetis, probably a form of organic delirium resulting from fever, caused fluctuating pulse rates and spastic movements. Mania and melancholy were more similar to contemporary notions of mental disorder. Mania denoted chaotic thoughts, frenzy, anger and delirium without fever. Melancholy resembled modern depression, including symptoms of sadness, fear and despondency. But melancholy also included states of paranoia and catatonic stupor that we now associate with schizophrenia, and its main symptom was withdrawal from external reality to an impenetrable inner world.

2. And don’t forget the humors. Ancient Rome continued to ascribe to the teachings of the famous Greek physician Hippocrates who thought that madness resulted from an imbalance of four bodily fluids or humors. According to the theory of humors, surplus yellow bile caused raging mania and excess phlegm caused quiet mania. A surplus of black bile caused melancholy – from the Greek melan meaning black and chole meaning bile. Its distinct symptoms were sadness, fear and despair. While we no longer think in terms of humors, this idea is not so far, in principle, from the modern day notions of hormone imbalances contributing to mental disorders.

3. Crazy cures. Bloodletting, emetics and purging were among the methods employed to expel harmful surpluses of a humor in Ancient Rome. Various herbs, drugs, proper diet as well as hot and cold baths were also used in the belief that they would restore health by stabilizing the humoral balance. When the herbs and drugs made individuals sweat, vomit and have diarrhoea, it was taken as a sign that they worked. Other recommended treatments included chains and whipping, and infusions of gladiator blood.

4. Moral weakness and dangerous goddesses. The idea that mental illness is caused either by moral failing or the peril of a femme fatale dates back to Cicero (106-43 BCE). According to Cicero, Insania was a relatively mild condition caused by a failure of will whereas Furens was a serious and total lack of mental reasoning that made individuals unable to function in normal life – inflicted by the angry, avenging “Furies” (a trio of bloodthirsty goddesses of Hades who could make people seriously crazy).

5. Progressive and prescient ideas. Asclepiades of Bithynia, born in what is modern-day Turkey, rejected Hippocrates’ humoral theories and instead taught that disease resulted from conditions of solid particles (an idea related to the developing idea of the atom). Asclepiades advocated for fresh air, light, appropriate diet, hydrotherapy, music therapy, massage, and exercise rather than darkness and torture for individuals with mental illness. These humane ideas got some early traction, but with the rise of Christianity and the decline of the Roman Empire, the idea that madness was divine punishment or demonic possession gained currency and triumphed for centuries.

No doubt… I am glad that much of Ancient Rome remains today. I am grateful that some of Ancient Rome is only remembered as history. And I am sure that every Roman Holiday has its own magic.

Picture of Kathleen M. Pike, PhD

Kathleen M. Pike, PhD

Kathleen M. Pike, PhD is Professor of Psychology and Director of the Global Mental Health WHO Collaborating Centre at Columbia University.

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