Revisiting Greek Psychiatry

Abstract

Revisiting Greek Psychiatry James Phillips*, MD (bio) Dr. Otto Doerr-Zegers's article is so interesting and insightful that I have nothing critical to say about it. On the other hand, in finding Greek, mainly Platonic, origins for psychotherapy, he offers us much to think about. In this brief commentary I will attempt to draw out some of the implications of his analysis for contemporary psychotherapy. Doerr-Zegers's analysis begins with a reflection on Socrates' Maieutics, Socrates' invoking the midwife metaphor to convey his use of dialectics to bring forth the ignorance of his interlocutor. Dörr recognizes that Maieutics is a kind of psychotherapy in that, like psychotherapy, it involves a "treatment by the word." He takes this verbal dimension of the treatment back to Hippocrates and even back to Homer. He notes that for Homer the therapeutic word is always accompanied by a charm of incantation—an epodé. He then adds that Plato takes up this treatment, removing the magical quality of the epodé and replacing it with the power of the physician's word. Plato's further analysis, presented mainly in his dialogue Charmides, emphasizes that all medical acts, however physical, require a psychotherapy component, just as all problems of the 'soul' must begin with consideration of the body. Charmides consults Socrates because of disturbing headaches. Socrates tells him he has a cure, a pharmakon, which is a simple leaf. He then adds that the pharmakon will not work unless accompanied by an epodé, a beautiful speech. "And I said that it was a certain leaf, and that there was a charm to go with it. If one sang the charm while applying the leaf, the remedy (pharmakon) would bring about a complete cure, but without the charm the leaf was useless" (Plato, 642/156). Plato adds, finally, quoting a Thracian doctor: "And the soul…my dear friend, is cured by means of certain charms, and these charms consist of beautiful words. It is a result of such words that temperance, sophrosyne, arises in the soul, and when the soul acquires and possesses temperance, it is easy to provide health both for the head and for the rest of the body" (643/157). Doerr-Zegers thinks of sophrosyne as the goal of treatment, and he remarks on how difficult it is to translate this important Greek word and concept properly. The concept refers to the ideal of a well-balanced individual with characteristics such as temperance, moderation, prudence, and self-control. In the symptom-based treatments of recent centuries, there is scant mention of temperance or sophrosyne. In reviewing the fate of Greek psychotherapy in the ensuing centuries and into the present, what do we see? We begin with the dramatic changes of the seventeenth century, a period that included the rejection of Aristotle (and Plato), the philosophies of both Descartes and the English empiricists, and [End Page 291] the scientific revolution represented by Galileo and others. With these changes, any notion of an Aristotelian unity of body and mind/soul was torn asunder, including the synthesis described by Dörr as Greek psychotherapy. This way of thinking continued, often represented by a contrast of subjective and objective knowledge. Kant, for instance, analyzed the conditions for objective knowledge in the first critique and the conditions for a more subjective experience in the second critique. The nineteenth century witnessed both the idealist tradition and further empirically based philosophies. For our purposes, the nineteenth century also witnessed the early development of psychiatry, and we now turn our attention to that. From its beginning psychiatry focused on symptoms, more specifically psychotic symptoms. We may thus loosely compare the nineteenth-century psychotic with Charmides, who came to Socrates for treatment of his headaches. Socrates treated him with a leaf/pharmakon and specified that it would only work if accompanied by "beautiful words." In contrast, most early nineteenth-century psychiatrists tried almost every imaginable physical treatment, although others like Pinel and Tuke developed "moral" treatment centers that could be compared to Socrates' beautiful-word approach. Their efforts largely failed because of the volume of patients committed for treatment in the nineteenth-century asylums. Further into the century...