History of Mental Health Series: Is there a Healthy Mind in a Healthy Body?

Foreword

History of Mental Health Series is a set of articles that reviews the history of mental health from a sociological perspective: from the ancient to the modern understanding of the concept. Nowadays, mental health is one of the most widely discussed topics; however, it had a hard, alluring history of development through centuries. The following six articles explore the history of mental health and some of the most fascinating and sometimes unbelievable facts about the topic, aiming to raise awareness about mental health and its importance of one’s wellbeing.

1. History of Mental Health Series: Mental Illnesses and Demons

2. History of Mental Health Series: Is there a Healthy Mind in a Healthy Body?

3. History of Mental Health Series: The First Asylums  

4. History of Mental Health Series: Chlorpromazine and the Drug Revolution 

5. History of Mental Health Series Deinstitutionalization and Community Care 

6. History of Mental Health Series: Stigmatization of Mental Health 

7. History of Mental Health Series: Mental Health in an Unequal World

Is there a Healthy Mind in a Healthy Body?

The previous mental health series article covered some of the most popular approaches to treating mental illnesses in the Ancient World. As discussed in Mental Health Series: Mental Illnesses and Demons, in some ancient civilizations, mental illnesses were attributed to supernatural forces. In other societies, mental illness was considered as a display of God’s wrath upon individuals for their trespasses. The following article focuses on mental illness in the Hippocratic era, when a healthy mind in a healthy body was the core of medicine, and the Middle Ages, which was diverse in terms of treatments.

Mens sana in corpore sano- “Healthy mind in a healthy body” (Juvenal)

Figure 1: Hippocrates

One of the outstanding eras in the history of mental illnesses was between the 5th and 3rd centuries BCE, when Hippocrates, who is considered the Father of Modern Medicine, and other European great minds suggested a new perspective on mental health. Hippocrates introduced the concept of physis and contributed to the transition of medicine from magic-based treatments to rational disciplines which combined theoretical knowledge and practice. “Hippocrates introduced a holistic approach to medicine, warning doctors not to interfere with the body’s ability to heal itself, as well as to treat the body as a whole – mind, body, and spirit.” (King, 2020) Destroying the idea that mental illnesses were caused by demons and unearthly forces, he claimed that the roots of those problems stemmed from pathology in the brain. He introduced the concept of the four essential fluids of the human body—blood, phlegm, yellow bile, and black bile—the combinations of which produced the unique personalities of individuals (Butcher et al., 2007).

As mentioned above, Hippocrates altered the discussion around mental illnesses. Moreover, he explored and classified various mental illnesses such as Disobedience, Paranoia, Panic, Mania, Phrenitis, Melancholy, Epilepsy, or Hysteria (Meletis, 2010). In the Asclepieion of the island Kos, where Hippocrates received an education, before diagnosing mental illnesses, healers had to observe the patient, identifying and considering causes (for example the balance of the four liquids: blood, phlegm, yellow

Figure 2: Asklepeion of the island of Kos

bile and black bile), and afterward, they could proceed with the treatment of the patient. (Meletis, 2010). In the Asclepieion of Kos, mental illnesses were treated properly with drugs and therapies as other diseases. It was believed that mental illness was the effect of nature on man, and the brain was the organ responsible (Ivanovic-Zuvic, 2004).

Art therapy was one of the most used methods in Ancient Greece to heal mental illnesses. Involving music, theatre and other forms of art, this method was considered to be effective for both the mental and physical wellbeing of the patient. A healthy mind in a healthy body was the core of Hippocratic medicine, suggesting that healing the body would heal the soul, and vice versa (Conrad, 2010). One of the most popular places for emotional cleans and catharsis was the theatre. Moreover, in order to facilitate mental healing, ancient Greeks created quiet rooms with the purpose to let individuals rest, sleep and dream so they can reach harmony and mental stability (Ouzouni, 2006). It is worth mentioning that Ancient Greece was not the only civilization that used arts as a form of therapy and source of healing and catharsis. In Egypt, the treatments used to heal individuals with mental problems involved recreational activities to achieve inner balance. Despite their advancement in medicine, the illnesses that Egyptians could not explain scientifically were considered as consequences of unearthly forces; therefore, magic and incantations were used to treat them (Butcher et al., 2007). Similarly, in Assyria, Babylonia, and the Mediterranean-Near East, alongside exorcism and prayers, music and art were used as a tool to achieve harmony and healing (Rosen, 1968).

Figure 3: Brekelenkam Bloodletting

The Middle Ages brought different approaches and methods for the treatment of mental diseases. The four essential Humours of the human body were still centre of attention. Similar to Hippocrates, healers of The Middle Ages believed that the imbalance of those fluids was the reason for mental illnesses; however, their treatments involved vastly different techniques. They used purging and phlebotomy (bloodletting) to help the patient to restore the natural balance in her/his body. For instance, tapping or pressing specific veins such as the cephalic, saphenous, or haemorrhoidal veins to draw corrupted fluids away from the brain was a very common practice. Apart from this, they believed that losing some blood from the body would work to patients' benefit; therefore, blood used to be extracted from patients’ forehead, via leeches or cupping (MacDonald, 1981). Moreover, patients were given laxatives or emetics. Some of the most famous laxatives were Heira Lagadii, a mixture created by Ptolemy to cure Melancholy, and a similar mixture, Confectio Hamech used by Arabs. Both of these remedies consisted of various herbs such as aloe, senna, myrobalan, and other natural ingredients. Later, they started using tobacco to induce vomiting (MacDonald, 1981). In addition to the approaches listed above, diets were prescribed to patients with certain illnesses. Most of the diets consisted of lots of greens and almost no red meat (Porter, 2002).

Figure 4: Greek Bronze cupping Cup

Between the 5th and 3rd centuries BCE, Hippocrates, the Father of Modern Medicine, proposed a new perspective regarding mental illnesses. He introduced the concept of the four essential fluids of the human body — blood, phlegm, yellow bile, and black bile — the combinations that produced the unique personalities of individuals and had a tremendous influence on one’s mental or physical wellbeing. This idea destroyed the belief that mental illnesses were the result of demonic forces, and initiated a theory-based practice for helping mentally ill patients. With the core idea “healthy mind in a healthy body,” healers of the Asklepion of Kos began to cure mental illnesses using art therapies. Some of the most used practices were music and theatre. Later, in the Middle Ages, the approach to mental illness changes again. Understanding the importance of the Four Humours, healers tried to heal the body of the mentally ill person through different techniques of bloodletting or laxatives. The approach to mental illnesses was slowly developing, yet old civilizations could not find proper treatments for this issue. Alongside the inappropriate treatments, patients and their families were struggling with unhealthy social attitudes and stigmas related to mental illnesses, which will be discussed in the next article.

References:

• Butcher, J. N., Mineka, S., & Hooley, J. M. (2007). Abnormal Psychology (S. Hartman, Ed.; 13th ed.). Pearson Education, Inc.

• Conrad, C. (2010). The art of medicine: music for healing: from magic to medicine.The Lancet. 376(9757), p.1980-1981

• Foerschner, A. M. (2010). The History of Mental Illness: From “Skull Drills” to “Happy Pills”. Inquiries Journal/Student Pulse, 2(09).Retrieved from http://www.inquiriesjournal.com/articles/1673/the-history-of-mental-illness-from-skull-drills-to-happy-pills

• Ivanovic-Zuvic, F. (2004). Epistemological considerations about medicine and mental health in ancient Greece. Repositorio Chile Neuro-psiquiatr. Retrieved from https://repositorio.uchile.cl/handle/2250/163963

• Juvenal (B.C) The satires of Juvenal. London, Printed by A. J. Valpy. [Web.] Retrieved from the Library of Congress, https://lccn.loc.gov/41030935.

• King, H. (2020). Hippocrates Now: The ‘Father of Medicine’ in the Internet Age. London: Bloomsbury Academic. Retrieved from https://doi.org/10.5040/9781350005921

• MacDonald, M. (1981). Mystical Bedlam: Madness, Anxiety, and Healing in Seventeenth-Century England. Cambridge University Press.

• Meletis, J, Kostas Konstantopoulos (2010). “The beliefs, myths, and reality surrounding the word hema (blood) from homer to the present”. Anemia. 2010 (857657) Retrieved from https://doi.org/10.1155/2010/857657

• Kleisiaris, C. F., Sfakianakis, C., & Papathanasiou, I. V. (2014). "Health care practices in ancient Greece: The Hippocratic ideal". Journal of medical ethics and history of medicine, 7, 6. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263393/#b27-jmehm-7-6

• Ouzouni, C. (2006). “The therapeutic use of seclusion in a psychiatric clinic”. Νοsileftiki. 45(1), 68-77

• Porter, R. (2002). Madness: A Brief History. Oxford University Press.

• Rosen, G. (1968). Madness in Society: Chapters in the Historical Sociology of Mental Illness. University of Chicago Press.

Image References:

• Figure 1: Gerard Van Der Gucht. (1730–1770). Hippocrates Heraclidæ F. Cous. [Etching and engraving]. British Museum. . https://www.britishmuseum.org/collection/object/P_R-4-105

• Figure 2: Heiko Gorski. (2003). Kos, Asklepeion, Griechenland [Photograph]. Dáithaí C. http://daithaic.blogspot.com/2011/09/asklepion-of-kos.html?m=1

• Figure 3: Granger. (1660). Brekelenkam Bloodletting [Painting]. Fine Art America. https://fineartamerica.com/featured/brekelenkam-bloodletting-c1660-granger.html

• Fugure 4: Raen, R. (n.d.). Bronze cupping cup [Photograph]. https://collection.sciencemuseumgroup.org.uk/objects/co82563/ancient-greek-cupping-cup-cupping-vessel