The Ancients - The Birth of Physiology

Episode Date: May 12, 2022

The treatment of mental health has been rapidly growing and improving over the past few decades, but it actually goes back thousands of years.Whether it was the Ancient Greek physician Galen’s humoral theory - in which people’s mental health was determined by imbalances in the levels of four different substances in the body - or Roman Emperor Marcus Aurelius’ meditations for guidance and self-improvement, ideas of mental health and its treatment have ranged from the intriguing to the totally bizarre, but many of them still have uses to this day.Tristan is joined once again by Dr Nick Summerton practicing doctor and author of ‘Greco-Roman Medicine and What it Can Teach Us Today’, published by Pen & Sword.The OSPP Four Temperaments TestFor more Ancients content, subscribe to our Ancients newsletter here.If you'd like to learn even more, we have hundreds of history documentaries, ad free podcasts and audiobooks at History Hit - subscribe today!

Hi, I'm Tristan Hughes, and if you would like the Ancient ad-free, get early access and bonus episodes, sign up to History Hit. With a History Hit subscription, you can also watch hundreds of hours of original documentaries, including my recent documentary all about Petra and the Nabataeans, and enjoy a new release every week. Sign up now by visiting historyhit.com slash subscribe. It's the Ancients on History Hit. I'm Tristan Hughes, your host. And in today's podcast, well, this week is Mental Health Awareness Week. And you might have noticed on other history hit podcasts this week that we've been releasing episodes looking at the history of mental health in various time periods, whether that's the Middle

Ages or early modern or perhaps more recent history. And today we're going to be doing a similar thing on the Ancients podcast. We're talking all about the birth of physiology. We're going to be exploring this idea of the four humours with our guest today, who is Dr. Nick Somerton. Nick has been on the podcast a couple of times before last year. He came on the podcast to talk all about Roman eye care. It was quite a gory episode, but it was really interesting nonetheless. And he also came on to talk about the Antonine Plague, figures such as Marcus Aurelius, Galen, and so on. Now, I mentioned Marcus Aurelius, Galen and so on. Now I mentioned Marcus Aurelius and Galen, both of them we'll be talking about in today's podcast too. We're going to be covering

once again this idea of Stoicism, an idea which I think is very very important indeed and very significant, but we're also going to be talking about other figures, the figure who we're not sure was just one figure, Hippocrates, and how he fits into this whole birth of physiology, but also we're going to be looking at things such as Roman health retreats around the second century and on from there. But that's enough from me, without further ado to talk all about the birth of physiology and so much more, here's Nick. Nick it is great to see you again. Thank you so much for coming back on the podcast.

It's a pleasure. It's a pleasure. Now, I mean, you've been on the podcast a couple of times before to talk about Roman medicine boxes, eye care, lessons from the Antonine Plague, but now it's May 2022, and the birth of physiology slash, you know, mental well-being, there does seem to be lessons we can learn from the ancient world from the greco-roman world when we're looking at medicine and the early should

we say people who looked at this and looked at treatments to this yes certainly i mean i think there's quite a lot that we can learn from the ancients i think there's issues around their healing sanctuaries there's issues around stoicism but i think probably i'll perhaps start up talking a little bit about the humors and the sort of as you said the birth of physiology and I think to the Greeks the early Greeks they had very much a spiritual view about health. You mentioned the word humours there and just before we go too deep into that I think it's worth explaining what a humour is as we go through this description if you wouldn't mind because I, myself included, we're not exactly sure what humans are. Yeah, exactly. Well, what I was saying is the early Greeks had a sort of spiritual view about health. And then sort of around, I suppose, about BC 500, BC 400, they began

to think a little bit about the way matter in the universe was put together. And they talked about that all matter in the universe, including bodies consisted of four elemental substances and they talked about fire air water and earth and associated with those there were these elemental qualities heat cold water wet and dry and the physicians around the time of the Hippocratic physicians so Hippocrates and the other associated physicians around the time of Hippocrates sort of adapted those to look at the body itself and came up with the concept of humors the idea being that the body itself was made of fluids four different fluids which the mixing of these four fluids or humors was critical to health and these four fluids were blood, yellow bile,

black bile and phlegm. And those are the humours. And these had to be correctly blended. They had to be correctly mixed and they had to be of the right amounts for a body to be healthy or Eukrasia, as they called it. That's what humours were. It was the idea that there was some structure to the body. The body worked in a certain way. The original idea was, it was the idea that there was some structure to the body, the body worked in a certain way. The original idea was that it was about an act of God. So if you became ill, it was an act of God and you had to appeal to the gods to get better. And so what the Hippocratic physicians were really saying was the body worked in a certain way. And their idea of physiology was that there were these humours which had to be in a certain

balance. And if they went out of balance, it would cause disease, both in terms of the body, but also in terms of mental disease as well. And the other interesting feature of this is that they began to realise that humours, well, the theory about the humours was that it was very individualistic. So they would vary by lifestyle, vary by age, vary by season, and vary by temperament as well. So again, people's personalities, their characters, they were also related to the types and the levels of humours they had in the body. So that's really interesting, Nick. So it's one of the key things that you mentioned there, and I just want to restate because it it sounds so important is that this transition that occurs around the time of these people around the time

of hippocrates if hippocrates was a real person that it's this transition as you say focusing on you know reasons being the spiritual into trying to understand why these things come about and perhaps maybe in a way try to treat them as well try to explain them exactly i mean i think once you've got a theory for how the body works, then, you know, a physiological theory, then you can begin to think about what you're going to do to put things right. And Hippocrates and the Hippocratic physicians, and then subsequently Galen, the Roman physician,

began to talk about things that Galen would call non-naturals, a way of actually trying to alter the humours in the body. And his non-naturals were things like pure air. It was about sensible eating, about diet. It was about exercise. It was about sleep. It was about modifying these sort of elements of your lifestyle so that you could adjust the humours so that you began to if you like get your body back to a eucrasic state in other words a balanced state so the blend if you like in the body of the humors was actually back to what it should be so that's really what Galen Hippocrates started and Galen was a great advocate of in his books that he called hygiene trying to deal with these issues

around diet, exercise, sleep, and sensible eating. But of course, there were other treatments they used as well to try to rectify the humours. One that we're all probably still aware of is bloodletting or bleeding, that was important, purging as well, and also things like bathing. They were all important in trying to get the humours back to what they should be. So I think the big change in the Greek world and then taken on by Galen in the Roman world was realising that actually it wasn't just about appeasing the gods, it was about realising that there was a way the body worked and you could modify the way that the body worked to try to get things back into balance, if you like. Now, you mentioned there Galen, and we will delve into a bit more about Galen right away,

Nick. But I mean, first of all, it does seem to be quite a significant period of time between the likes of Hippocrates and the Hippocratic people and Galen. If Galen, if I'm correct, we're talking about the second century AD and the Roman Empire. I mean, even though these are two key figures in our story today, I mean, do we know anything about whether treatments evolved between Hippocrates and the time of Galen? Or is it very much we hear about the humours of Hippocrates, and then they come back several hundred years later from the limited sources that we have, and it's Galen who therefore seems to really progress these thoughts further and the second century Roman Empire? Yeah, I think there was an evolution.

I think Galen was a great follower of the, or Hippocrates or the Hippocratic writings, because as you said earlier on, we're never quite sure that there was one individual called Hippocrates, more likely a variety of individuals writing about these issues. So I think what Galen did was to take the Hippocratic ideas, and in fact, he wrote about, he wrote commentaries on the Hippocratic writings as part of his major collection of books that he produced during his lifetime. But he took the Hippocratic writings and developed them further. And I think one of the things that he was particularly interested in was something he called temperaments. So the idea that not only diseases, but people's

characteristics can also be related to the level of humours and the way they behave, the way they feel about certain things, and the way mental illnesses can occur. And even nowadays, we talk about these temperaments, we talk about the sanguine person, we talk about the choleric person, the phlegmatic person, or the melancholic individual. And all of these are actually go back to Galen and to Galen's idea of the humours and the way they affected people's personalities, if you like. I mean, the melancholic is somebody who's got extra black bile, if you like, and they're often a sort of rather depressive sort of individual. The phlegmatic person, an excess of phlegm, calm person. That was the way Galen saw it.

The sanguine individual, too much blood and a cheerful sort of person. Again, that was the way he saw a sanguine individual and the choleric individual, which sadly, when I've done a survey recently, I've been labelled as choleric, which means angry, irritable, short tempered. And in fact, if listeners are interested, they can actually assess their own tendencies in this area by going on to the OSPP for temperaments test. OSPP for temperaments test. You can just Google that OSPP for temperaments test. And you can actually assess how choleric, how sanguine, how phlegmatic or how melancholic you are. But this all goes back to Galen. And he wrote a whole book called The Temperaments. So it was really the idea that mental illness was not only about major alterations in the humours, but also about small changes which determine your personality. One key question, just before we keep going on that, we mentioned Galen in the second century

in the Roman Empire, and I think we got quite an idea of who he was, but can you kind of explain exactly who this figure of Galen was? Was he quite a prominent medical figure in the second century Roman Empire? He was quite near the top, wasn't he? Well, right at the top. I mean, he eventually ended up as the physician to Marcus Aurelius, but he started off in Pergamon over in Turkey and then worked his way to Rome via Alexandria, gaining a lot of experience in physiology, anatomy, a lot of reading. In fact, his medical training took 11 years, which is longer, probably twice as long as you'd train a doctor nowadays. So he was also very interested in language. He was interested in philosophy, highly educated individual. His father had been an

architect actually over in Pergamon, and he wrote extensively throughout his whole life. Scores of books were produced by Galen, which survived right through into medieval, well, they've survived to today, but their influence of the writings continued into medieval times, into the 16th, 17th century. But even in terms of his approach to the humours and temperaments, that survived right to the 19th century and even to today actually we even nowadays we still talk about sanguine phlegmatic people so his influence was long-standing but he had a an interesting life not only as i say physician to marcus aurelius towards the end of his life but also having to deal with uh commodus and his various problems after marcus aurelius died and the anton Plague. But a very

prominent Roman doctor, probably so prominent that some other good doctors of the time, like Rufus of Ephesus, tend to be overshadowed by him, sadly. And I think nowadays we're trying to rectify that balance a little bit and look at some of the writings of others from that time as well. Because he was probably, if you met Gellin, you'd probably find him quite arrogant. You'd probably find him a slightly choleric character as well, because he was very easily irritated, I suspect, by his colleagues, and his writings do show that tendency.

Oh, my goodness, Nick. I mean, in the pub next time, if someone annoys me, I'm just going to, you know, I'm going to say something. Oh, you're a phlegmatic person, aren't you? Or you're a melancholic or you're a choleric person they won't know what hits them but but let's let's bring this to the modern day as well because as you said this personality test which has its you know its origins in the ancient world of galen you've been doing a lot of work on this and you've recreated one of these tests that anyone listening to this can go and take following

listen to this podcast yeah no no i wouldn't take credit for myself it's all it's freely available online it's been developed by uh psychologists so it's it's been properly developed but i've just done the test when i discovered it and i would recommend and it gives you it tells you what your dominant humor if you like your your dominant temperament is so mine came out as cler, but I have a little bit of phlegmatic and sanguine and melancholic elements as well. And you'll see if anybody wants to do it, it's 24 questions. It's interesting, probably a bit of fun, but also probably of still some relevance. I think there are still some modern psychologists of the last century in particular, Kant and also Pavlov, who again thought that there were four temperaments so I think the four temperament

idea is still sort of hanging around there and so yeah worth it's an interesting thing to do and something to share with your friends I think absolutely I actually did it this morning and I know a few of my co-workers they did it yesterday I mean I was I was quite happy I got sanguine with quite a bit of phlegmatic and choleric on the side it's quite interesting to see the results and how they it's a fun little thing to do. As you say, it doesn't take much time and it's something that anyone can do. And we'll put a link to it in the description below.

Oh, sanguine's nice. I mean, sanguine's cheerful. Phlegmatic is calm. And so those are the ones you want to get. Probably less choleric like me, I think, probably. I can see your anger just erupting from the screen there. As if, as if, friend um but let we have to move on this has been really interesting so far but we're going to focus still around

aunt Galen and the second century AD because I mean you have these four humors you have this personality test how would someone like Galen therefore go about treating people who he thought perhaps he had someone who was maybe too melancholic or someone who was too choleric or maybe just too phlegmatic or something like that how do you think they would go about treating mental illnesses yeah well as i say they have the non-naturals so again sensible eating exercise getting enough sleep uh those were all important to galen but let's look at one particular example let's go for a melancholic person because that's probably somebody comes up melancholic so a

melancholic person has got too much black bile is what Galen would say so how would you adjust somebody's black bile so I think what you get them to do is to eat less raw foods for example you'd say don't have so much cabbage. It's a slightly bizarre thing. That would be one of Galen's bits of advice. He'd actually say, you need to look at lifestyle a bit more. So don't stay up too late at night. Don't overwork.

Drink more fluids, less alcohol. Actually, when you think about it, if a melancholic person is a depressive, a depressed sort of person, that actually makes a lot of sense to modern doctors as well. You want them to watch their work-life balance. You want them to get a bit more sleep. So it makes sense. One of the things I really like about the black bile is actually sending people off to the seashore, to coastal areas, to breathe in the sea air. Again, something that we might talk about today, go and take the the waters go for a 15 minute walk after dinner

so these were there were precise things that Galen was saying so if you were somebody who he assessed had got too much black bile then that's the sort of things he would recommend before he started sending you off for having some massage or some bathing or some bloodletting or purging or cupping those were very much second and people think that that's what the ancients were doing all the time, that they were purging you or they were taking blood off you. But actually sensible exercise, walking along by the seashore, not having too much cabbage and not overworking, getting good work-life balance, that would sort out your black bile.

That's what Galen was saying. And I think nowadays we might not agree with the humoral ideas but actually we would probably still make those similar for the recommendations for other reasons absolutely it's still interesting to cover nonetheless but as you say you know this wasn't the only thing that was happening in the mid-second century when talking about things such as mental illnesses and so on or things to help with treatment of it is it seems around this time we also see nick this real rise in stoicism or it really comes to the prominence doesn't it by the likes of galen and others can you explain a bit more about this and how this fits into our whole discussion today yeah i mean i think galen was really interested in developing a philosophy of life i said said earlier on that he had been interested in philosophy and language.

And I think many Romans at that time were interested in a philosophy of life. Philosophy nowadays is seen as something that resides in university departments, not in sort of marketplaces or restaurants. But for the Romans, philosophy was part of what they did. And I think Stoicism was one of the philosophies of life that was becoming very prominent around Galen's time. And Marcus Aurelius in his book Meditations was a great proponent of Stoicism, as was Seneca around the same sort of time as well. And Stoicism, there are really two or three key features about Stoicism. Probably the most important one is appreciating that there are things in your life that you can control and things that you can't control.

So, for example, you can't control other people's opinions about you. You can't control your wealth, really. You can't control your reputation, your mortality or the effect of pandemics, actually. You can't control, you know, where they had the Antonine Plague, we have coronavirus. We can't control those, but we can, as individuals, control our reactions and our behaviours to them. And I think that's really one of the things that's critical about Stoicism, is that it's not so much the problem, it's the way you perceive the problem and the way you reacted to the problem so

that was very critical and I think the Galen and both Galen and Marcus Aurelius were trying to get people to stop worrying about things that were beyond their control because if you stop worrying about things that you can't control like people's opinions of yourself or your reputation that leads to stress anxiety and depression so it's very much trying to control the things that you are you can control rather than things you can't and behaviors and your reactions are critical to that i mean nowadays we don't talk really about stoicism so much what we talk about in terms of medical treatment we talk about cognitive behavior therapy and cognitive behavior therapy if you just go go onto the NHS website, it actually says that this is about

changing the way your state of mind in terms of the way you deal with problems, you deal with events. So again, a very similar approach. I think the other thing about stoicism is to control insatiability, the idea that we want all these different things all the time we want the latest mobile phone we want the latest gadget all these things again can lead to unhappiness and I think one of the key things about stoicism is to be aware what's important and I think probably something about living through the coronavirus epidemic has helped us to focus a little bit more on what we value as opposed to you know what's nice to have but it isn't of particular value and I think writers on stoicism modern writers on stoicism sort of list

a number of things that it's worth thinking about in terms of values what ultimately is the most important thing in your life to you and what do you want to be remembered for after your death what sort of character do you want to have these are the sort of things about trying to assess your values and so that thinking became very important to the likes of Galen and the likes of Marcus Aurelius and Galen writes a very nice piece about when there was a fire in Rome, how he coped with the loss of all his books, many of his great medical instruments, and also how he coped with having to live under the Emperor Commodus,

wondering whether he'd be killed or sent off to an island. And he very much went back to Stoicism, realising that he can't control the nature of the Roman Emperor, or the fact that there's been a fire and burnt all his books, but he can control how he reacts to it. So I think it's this sort of what we call in modern parlance cognitive behaviour therapy. But it's also, Galen was also keen on meditating from time to time during the day, trying to work out what things, we call call it negative visualization now in terms of cognitive behavior therapy thinking about what your life would be like if you lost your house

what would be like if you lost your partner if you lost your job if you lost your life it helps to get things into perspective a little bit so stoicism very important to Galen, Marcus Aurelius and many Romans of that time as a philosophy of life and interestingly quite important to Galen, Marcus Aurelius, and many Romans of that time as a philosophy of life. And interestingly, quite important to many modern people who, because the sales of Marcus Aurelius' book Meditations went up during the coronavirus epidemic. And I think people were beginning to decide what was important to them and realizing that were things they could control and things they couldn't. And I think that's the heart of Stoicism. History tells us that in 1455,

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every Saturday for brand new episodes. now nick you did mention then marcus aurelius and his book meditations and it feels we must talk about this a little bit first of all who is marcus aurelius and what is his book of meditations it seems to link hand in hand with this idea of stoicism and and and to this modern day yeah yeah well marcus aurelius roman emperor again around the time of so we're talking about the end of the second century around the time of galen probably one of the last of what we call the good emperors and very well liked by his colleagues at the time but very focused on meditations were his own thoughts about how to deal with things on a day-to-day basis and it might just be worth me just quoting something from meditations something about how Marcus Aurelius

started the day just a short quote in terms of he was concerned as we are about people's opinions and and attitudes and even as emperor he couldn't necessarily control people's opinions and attitudes about him but he used to say begin each day by telling yourself, today I will be meeting with interference, ingratitude, insolence, disloyalty, ill will and selfishness, all of them due to the offender's ignorance of what is good and evil. And then he went on to say, but everything is what your opinion makes of it. And that opinion lies lies with yourself renounce it and you will at once have rounded the foreland and come across a calm tranquil sea and so he was saying that you're going to have to encounter all these things but actually it's the way you think about them that

matters more than anything i mean it's quite interesting actually shakespeare in hamlet says well hamlet exclaims why then tis none to you for there is nothing good or bad but thinking makes it so and again he was saying exactly the same thing you know it's not good or bad in itself but it's the way you think about something that can change and make it feel good or bad and then the way you react and then the way you feel about that generates that stress anxiety depression so we call it cognitive behavior therapy they call it stoicism but it's all about a talking therapy to try to get you to change the way you think about things

now so that seems one sort of way to try and change thinking and to help treat this and i'm a huge believer of stoicism and this idea as you said like i'm of reacting to things that you have control over and try not to go crazy over stuff that you can't control as you say and it is really powerful and really helpful at least in my opinion but the next thing i'd love to talk about kind of keeping on this vein something that i know you'd got a lot of work on and that you'd love to talk in detail about which is health retreats ancient health retreats nick i mean talk to us about this did the romans believe in having these health retreats to help with mental health problems yeah i mean healing sanctuaries were really important to the greeks and to the romans and and actually after the time of marcus aurelius they had a resurgence

and these healing sanctuaries i think probably worth outlining first of all what they were really they were sort of isolated collections of buildings and spaces, often in sort of stunning locations, hills, in woods, in contact with nature, good views, probably with a source of water nearby for drinking and bathing. And what they were, were sort of temple complexes. So there'd be a temple in the centre of it, and around there would be space for exercise, for rituals, for festivals, processions. Occasionally you'd find libraries, you'd find theatres, you'd find gymnasia, you might find accommodation.

And good examples of these sort of healing sanctuaries, Epidurus in Greece is a good example that people might have visited. Athens has one. There's one in Corinth as well. And the island of Kos, where many of the Hippocratic physicians came from as well. Again, another good example of a healing sanctuary. But a little bit closer to home, the Romans developed them in the United Kingdom as well. So Bath is an example of a healing sanctuary. A little bit difficult in a busy town to understand the nature of a healing sanctuary a little bit difficult in a busy town to understand the nature of a healing sanctuary but just up the road at Lydney in Gloucestershire there's a fantastic healing

sanctuary the Temple of Nodens which is open it's on private land it's open from time to time and it's possible to visit but there you have a little temple complex which you can still see to this day a bathhouse you can see the accommodation for the pilgrims who would have visited the sleeping rooms they had what they call abatons which were ritual sleeping rooms as well and you can still see those today on top of a lovely hill so the location there for the temple of nodens at lidney is fantastic and you just see the sort of river seven sneaking away below you so you feel better just arriving there, actually, once you've had a walk up the hill to get there.

So they were important in terms of their locations and the different facilities that they offered there, but they were well spread throughout the whole empire. And Aeschylae was probably the best known of all the deities that was venerated there. I mean, quickly, going a bit further on that, Nick, you mentioned how there seems to be a resurgence following Marcus Aurelius and the reign of Marcus Aurelius.

Now, why is that? Why would that be? Historians call it an age of anxiety in some ways, that after Marcus Aurelius, there was a period of, you'd had the Antonine Plague, and then you had a slightly chaotic period in the empire with coming up to Septimus Severus, Commodus, you know, both the sons of Marcus Aurelius and the sons of the Emperor Septimus Severus were nothing much to write home about, to be quite honest. And then you ended up the period of sort of multiple emperors, this sort of chaotic period of the Roman world. So I think after the good emperors, which ended in Marcus Aureliusus we're hit at that sort of period by the antonine plague and then we had a period of not so good emperors and empire the economy

the emperor not being quite so good as well so there were lots of pressures on people and i think there was a resurgence and interest and you see it not only in terms of the architecture but in terms of the coinage you see more representations of Aesculapius being the healing god being represented on the reverse of coins around that sort of period as well and certainly Nodens the temple of Nodens had been the well it had been an iron working area on the top of that hill outside Lydney but it was developed over the period of sort of you know third century onwards really you see the developments occurring then and and other healing sanctuaries that may be nearby there as well i

mean there is a suggestion that there were a number of healing sanctuaries along the seven corridor chedworth great wickham which we see as villas some people might think of them as healing sanctuaries as well as bath and possibly something at kerwent as well as Lydney. So there was the idea that there were a number of these healing sanctuaries around at that sort of time being developed. It is interesting. I think it's a more human part of the whole ancient story, isn't it, Nick? If there was someone who was based up at Hadrian's Wall, whether as a soldier or as someone else, you know, you were living up there. But, you know, for some reason or or another it was really getting to you and the fact that you could go further down south as you said perhaps to one of these places at Lydney or wherever one of these healing sanctuaries

it's fascinating you mentioned those ones in the central Mediterranean you know the Asclepius the god of healing and all of those places Epidaurus but it's so interesting to see that there was one closer to home on the further extreme of the Roman Empire but that those facilities as it were were there I mean it's remarkable to I can imagine going to see those sites now and trying to understand you know almost 2,000 years ago these were important places for people you know as healing sanctuaries. They were and I think it's interesting you mentioned about Hadrian's Wall because the there was no doubt that wounded soldiers or ill soldiers, we have probably a hospital at Halsted's on Hadrian's Wall, but it was quite a small hospital. And the question has always been, where did they go for rehabilitation and recuperation afterwards?

And if you look at the dedications that have been left at places like Bath in this country, they often are from soldiers from Lincoln or Chester. So people, you know, soldiers will have travelled away to actually get to these healing sanctuaries. So there would have been some pilgrimage, if you like, some travel to get there. And I think once you arrived, you would find somewhere where, going back to what we talked about humours earlier on, you're a site where you could have your humours put back into balance, if you like. You know, we've talked about the humours coming from

air, fire, water, and earth. You know, these humours were originally from those elements of Greek thinking. And if you go to somewhere like Lydney, even today, you'll feel the pure air. You can certainly, it requires an exercise to get there you've got to walk up the hill you'll be walking around these sites as well and you can see the bathhouse where they would have experienced the waters so I think the idea of being in contact with the fresh air the earth the sunlight that would have been the ancient fire I suppose and the water as well and at Lydney they had very iron rich waters as well which people would have bathed in as well as was drunk as well. So you mentioned bathing there but and

of course you also mentioned that you had these healing sanctuaries all across the Roman Empire I mean bathing aside what what sorts of treatments do we think would have been on offer at these healing sanctuaries? Well I say aside from the sort of the standard sort of hygiene treatments the fresh air the contact with nature i mean the the japanese call it forest bathing nowadays the romans would be familiar with that idea of shinrin yoku the idea of being amongst the trees or within the coastal areas so people are very keen on that but the romans were there already they were they were doing this so so the the fresh air the contact the exercise to get there you know the

ability to get some rest when you arrive but there were particularly psychological therapies being offered there some of which perhaps 50 60 years ago we might have thought was a bit crazy but nowadays they're sort of fairly main mainstays of the sort of treatments we might offer to our patients nowadays with anxiety and depression so in terms of restoring tranquility as they talked about music and singing were very important so keelius aurelianus talks about you know piped music for anxiety and depression and it's quite interesting to hear radio reports recently about the emphasis of we want more music therapy to help treat people with anxiety and depression after coronavirus so so music and thinking was important visual arts were seen as important and the the healing site

at Athens was renowned for its collection of art and collection of sculptures and statues reading reciting poetry the healing site Epidaurus and many of them have fantastic theaters and tragedies and comedies again going, going back to stoicism, they might be a way of helping to get things back into perspective, listening to a tragedy, watching a comedy, get you to think in a different way about things. And then obviously there would have been group therapy, individual therapy as well,

reading testimonials of people who've been cured in the past that would have helped their psychological wellbeing, as well as sort of looking at votives. Votives were things that were left in thanks for a cure or in anticipation of a cure. And you find them at many of the healing sites. You know, it might be, you know, representations of eyes. It might be a hand at a litany or breaths at bath. You see these around the place, these votives.

So those are the sort of psychological treatments we've got the hygiene treatments you know making sure you don't forget about the importance of exercise and and sleeping and sensible eating but also particular psychological therapies arts type therapies that we would talk about nowadays but also they had something called dream healing as well dream healing is a little bit more separate from the way we might practice today and it might seem a bit crazy really to some people but essentially what dream healing evolved was that people would come up and they would sleep in these healing sites in places called abatons and the idea is a healing god would appear to you in a dream and either cure you, which was less common, or suggest methods that you could use to get better.

And that was more common. And then you'd go and present yourself to a dream interpreter who would then work through and try to work out what prescription, if you like, the god had recommended for you. if you like, that God had recommended for you. And during these incubation, these dream healing sessions, there would have been priests circulating between the sleepers, probably accompanied with dogs and snakes, bizarrely, who would have licked you as they passed by. And those were key elements of the healing process. And there would probably have been narcotics freely available as well, opium and things like that, to be be honest to sort of ease your way into sleep but it was a it was a strange strange process but i think we are perhaps less negative about it should we say than we were there's been an interesting report in the lancet recently or in the last few years about the looking at the the licks the saliva actually of the snakes that would

have been in healing sites they were called zemesis longissimus the saliva actually of the snakes that would have been in healing sites. They were called Zermesis longissimus, the particular type of snakes. And it seems that the saliva actually did have healing properties. And the ancients write about, you know, they were lying in the abaton, the snake came past, licked their wound and it was healed. So it wasn't complete nonsense. And, you know, even now we talk about therapy dogs. I mean, a lot of people are great advocates and vets. And my daughter is a vet, is a great advocate of the importance of dogs for well-being. And I think many people would ascribe to that. So I think these dreams were a funny thing.

But I think it's something that we're beginning to perhaps reflect on a little bit more nowadays. There is an interesting guy in the United States called Edward Tick. He's written a book on dream healing. And actually, he is a psychologist. He's a credible individual. And he's actually taken various veterans from conflicts that the Americans have been involved in with post-traumatic stress to healing sites. Americans have been involved in with post-traumatic stress to healing sites and they've actually slept there or nearby and had healing dreams which he is convinced help with post-traumatic stress so dream healing is an oddity and it was part of the of what they did but it was also about trying to

get their humors back in so there was a bit of logic behind it so if somebody had a dream with smoke and mist and darkness you know their black bile was up the creek again or if it was a dream with with destructive fire there was something wrong with their yellow bile so all of these things were sort of interacting with each other I mean I know first of all if I ever saw a snake at a healing at a healing place that i was going to i'd literally run a mile because that's something i cannot do dogs absolutely snakes less so but i and i appreciate it's not exactly dreaming maybe maybe to an extent but do you think meditation can fit into this at all nick if we if we're talking about dream therapy alongside

that yeah i i think so i mean i think the meditation was seen as very important by galen it was important by marcus aurelius important by seneca as part of stoicism and they were very much about focusing on valuing things as as we've discussed earlier on things that things that are important in their in their lives and helping them to understand what's important by focusing on, you know, things they have already, their job, their life, their home. But you're right, meditation has got broader benefits as well. And Seneca himself writes about the importance of before he goes to bed every night, having a conversation with himself about how the day's gone, you know, really sort of unburdening himself, a bit like a court with him being both the judge and the jury and the person in the docker, I suppose. He took all three roles,

analysing his day. And that was his way of trying to improve his sleep, because again, sleep was very important to the ancients as one of these ways of sorting out your poorly blended or wonky humors trying to get your humors back into balance again so I think yeah meditation was important to the ancients and I think if we go a little bit away from the Romans into ancient Indian medicine I, they also were concerned with humours and probably their world has moved much more into the importance of meditation than probably we have, actually. But it was certainly seen as a way of sort of just reviewing the day. Very important to review the day. And I think all of the Stoic teachers, Seneca, Marcus Aurelius and Galen were

very committed to this. And they tried to do it themselves. And I know Galen describes trying to do it himself every day. Well, Nick, this has been absolutely great chat. Last but certainly not least, alongside that test, which once again, we will put a link in the description below. You've written a book all about Greco-Roman medicine, if I'm not mistaken. Yes, it's doing well. Came out last November, Greco-Roman medicine, what it can teach us today. Humors is a difficult area. And I think in the first chapter, perhaps I make it fairly straightforward and the lifestyle changes that they adopted and how they relate today to things that we can still do today. But in the chapter on

psychological well-being, I talk a lot more about stoicism and also a bit more about cognitive behavior therapy and also about these healing sites. So if people are interested, please do buy the book. Absolutely. Well, Nick, it just goes for me to say thank you so much for taking the time to come on the podcast today. Thank you very much for inviting me. Well, there you go. There was Dr. Nick Somerton explaining all about the birth of physiology, the four humours, Roman health retreats, Marcus Aurelius, Galen and so much more. I hope you enjoyed the episode. And yes, we will put a link to his test in the description below.

Definitely go and take that test. It was quite fun to do and it doesn't take too long at all. And you get the results straight away. Now, if'd like more Ancients content in the meantime you know you can subscribe to our weekly newsletter via a link in the description below. If you'd also be kind enough to leave us a lovely rating on either Spotify or Apple Podcasts, wherever you get your podcasts from, if you enjoyed the episode I would greatly appreciate it and it helps us as we spread the Ancients love further and further afield. But that's enough for me and I will see you in the next episode whether you're in your running era, Pilates era, or yoga era,

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