Mental illness in ancient Rome

Mental illness in ancient Rome was recognized in law as an issue of mental competence, and was diagnosed and treated in terms of ancient medical knowledge and philosophy, primarily Greek in origin, while at the same time popularly thought to have been caused by divine punishment, demonic spirits, or curses. Physicians and medical writers of the Roman world observed patients with conditions similar to anxiety disorders, mood disorders, dyslexia, schizophrenia, and speech disorders, among others, and assessed symptoms and risk factors for mood disorders as owing to alcohol abuse, aggression, and extreme emotions. It can be difficult to apply modern labels such as schizophrenia accurately to conditions described in ancient medical writings and other literature, which may for instance be referring instead to mania. Treatments included therapeutic philosophy, intellectual activities, emetics, leeching, bloodletting, venipuncture, sensory manipulation and control of environmental factors, exercise and physical therapy, and medicaments.

Anxiety disorders

Some Romans used magico-medical practices such as chants (carmina) and amulets to cope with anxiety and provide reassurance, but Roman physicians and philosophers classified severe anxiety as a diagnosable medical condition and developed theoretical approaches and therapeutic methods to address it. The Roman orator and sometime philosopher Cicero (1st century BC) distinguished between anxietas, worry about future events, and angor, an outburst of emotion. Galen, a Greek physician and surgeon who immigrated to Rome in the 2nd century, observed patients with symptoms resembling generalized anxiety disorder or major depressive disorder, such as sweating, indigestion, palpitations, dizziness, fever, weight loss, insomnia, changing skin color, low heartbeat, and an irregular heartbeat. People with this disease are described as having a progression of anxiety and sadness. It was believed that such anxiety could result in death. Galen theorized that this syndrome emerges from an emotion he calls lypē. Stoicism, as a philosophy centered on using self-control to overcome negative emotions, theorized methods of handling anxiety. Stoic methods have been reinterpreted in light of modern treatments for anxiety disorders, such as cognitive behavioral therapy. The Stoics practiced the technique of negative visualization, which involved considering the worst possible outcome of an action or event in order to prepare oneself for the consequences of it. They would rehearse mentally how they would respond to anticipated problems and try to find a way to change negative situations into positive outcomes. The purpose was to train the practitioner to have little fear and eventually be able to remain calm in difficult situations. The Roman Stoic Seneca believed that to cure anxiety, one must focus on the present moment. The Imperial-era historian and essayist Plutarch describes a Roman man possibly with scrupulosity, guilt or anxiety over religious subjects commonly associated with obsessive–compulsive disorder and obsessive–compulsive personality disorder (only OCD is recognized as an anxiety disorder). This man is described as "turning pale under his crown of flowers," praying with a "faltering voice," and scattering "incense with trembling hands."

Mood disorders Mood disorders were frequently described in Greco-Roman medical literature of the Roman Imperial era, including a condition resulting in poor appetite, lethargy, sleeplessness, irritability, agitation, long-lasting fears, and hopelessness, and melancholia, which is now known as depression. Galen believed this disorder also caused delusions, anguish, and cancer, writing that phobias and dysthymia, another depressive disorder, could cause melancholia. Alcohol abuse, hypersexuality, aggression, and extreme emotions were thought to increase the risk of developing this disorder. It is unclear whether ancient doctors thought of depression and mania as separate conditions or one singular condition. Rufus of Ephesus wrote that melancholiacs experienced episodes of fear, indigestion, doubt, and delusions. Rufus describes melancholiacs who thought that they were pots or that their skin had become parchment. He also observed melancholiacs who experienced changes in appearance and behavior, such as darkened complexion, protruding eyes, more hair, and disfluency. Rufus divided melancholia into three categories: type 1, when the body became completely filled with melancholic blood; type 2, when only the brain was affected; and type 3, primarily affecting the hypochdonrium. Soranus, also from Ephesus (in present-day Turkey), noticed that the condition of melancholics improved after they drank from certain alkaline springs nearby, which have been shown to contain lithium, a chemical element used to treat bipolar disorder. The Latin medical writer Celsus recommended bloodletting to treat melancholia, or hellebore to make the patient vomit if bloodletting was not an option. Patients were also to engage in exercise and intellectual activities, and abstain from wine. Other common treatments included applying cool materials to a patient's head. Aretaeus of Cappadocia, a Greek physician who lived in the Roman province of Cappadocia, describes melancholic patients who experienced episodes of depression and suicidal ideation alongside episodes of "impure dreams" in which they experience "irresistible desires." In this state they are easily angered by criticism and become "wholly mad." Aretaeus also describes people with this disease experiencing hallucinations and delusions. This disorder resembles bipolar disorder, which is defined by episodes of mania and depression. It was thought to be caused by too much black and yellow bile. Seasonal affective disorder is a medical condition in which the affected person experiences mood changes alongside seasonal changes. One treatment for this disorder is light therapy. The Romans knew that exposure to light could serve as a treatment for those affected by certain conditions. Cicero experienced several depressive episodes over the course of his lifetime. During these periods he kept a journal documenting his days, and his sadness. This technique has been found to alleviate depression and sadness, and it is a form of therapy still used today.

Intellectual disabilities

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