Galen’s Περὶ Ἀλυπίας as Philosophical Therapy: How Coherent is It?

in Galen's Treatise Περὶ Ἀλυπίας (De indolentia) in Context

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In this discussion, I consider Galen’s περὶ ἀλυπίας as an exercise in philosophical therapy of the emotions. I focus on the question how far it is a coherent work, when taken in this context. Overall, I conclude that it is largely coherent; but it also raises some significant questions in this respect, and consideration of these questions helps us to define the distinctive character of the work and its contribution to the genre.1

1 Galen’s Two Therapeutic Works: The Question of Coherence

By Galen’s time, Hellenistic-Roman writing on the therapy of the emotions formed a well-established genre. Although there are some earlier precursors (especially Plato),2 the genre was decisively shaped by Stoic and Epicurean thinkers.3 It was also adopted by Academic or Platonic thinkers, notably Cicero and Plutarch. Galen contributed to the genre in two surviving works, Avoiding Distress (περὶ ἀλυπίας = De Indolentia, or Ind.) and the first book of The Diagnosis and Treatment of the Affections and Errors Peculiar to Each Person’s Soul (Aff. Pecc. Dig.; first book is Aff. Dig.).4 Galen was the only ancient medical writer to do so, as far as we know; and this reflects his exceptional ambition to combine medicine and philosophy. His two writings in this genre are not, in any obvious way, influenced by his work as doctor, and reflect, to a large extent, the characteristic themes of philosophical therapy.5 Among earlier works of this kind, Galen certainly knew what was probably the key founding text in the genre, Chrysippus’ (lost) ‘therapeutic’ book (Book 4 of On Passions = peri pathōn), and criticised it extensively in The Doctrines of Hippocrates and Plato (PHP).6 However, he seems to have been more directly influenced by works such as Plutarch’s On Contentment (peri euthumias) and On Avoidance of Anger (peri aorgēsias). These are shorter and more practically oriented writings; they are also philosophically eclectic, or at least less uniformly shaped by a single intellectual approach than Chrysippus’ ‘therapeutic’ book or subsequent Stoic or Epicurean works in the genre.7 Even so, all these writings, including Galen’s two works, express certain broad conceptual patterns which go back, at least, to the Stoic-Epicurean roots of the genre. They do not only discuss the management or control of emotions (either emotions in generally or a specific emotion), especially negative, disturbing or distressing emotions, and recommend methods for promoting this process. They also reflect the claim, accepted in varying degrees by all the philosophical schools, that the roots of our happiness or well-being (including our emotional state) are ‘up to us’ or fall within our power as psychological agents. The overall project of philosophical therapy is to find ways of ‘curing’ painful or ‘diseased’ emotional states by exercising this agency. This depends, typically, on activating our capacity to develop the virtues, or to do so more fully; this process of development not only rids us of vices of character but also of negative or misguided emotions linked with those vices.8

Why is the question of coherence an important one to raise in connection with Galen’s works in this genre? Both of them offer some grounds for concern in this respect, regarding the choice and organisation of themes and also the conceptual framework applied. Aff. Dig., the longer work, can be seen as breaking down into two halves. The first half (Aff. Dig. V.1–27 K. = 3–19 DB), on emotions in general, is rather generic in its approach, and employs themes and methods of emotional management characteristic of a wide range of writings in this genre. The second half (V.27–57 K. = 19–37 DB), increasingly, focuses on a single vice, ‘insatiability’ (aplēstia), presented as underlying a wide range of emotional disturbances (V.45–52 K. = 31–35 DB). This theme is also handled in a more individual way, including a section on Galen’s upbringing and his father’s influence and the lessons learnt in that way, a section which is similar in content to the latter part of Ind (V.40–45 K = 27–30 DB).9 This contrast between the two parts of Aff. Dig. corresponds to the use of two distinct addressees, characterised in significantly different ways.10 The question of coherence also arises as regards the philosophical framework informing the approach to therapy. As I have argued elsewhere, Aff. Dig. displays an uneasy combination of Stoic-Epicurean and Platonic-Aristotelian approaches, marked by two main points of contrast. Stoicism and Epicureanism assume a unified conception of human psychology, in which emotions and desires are shaped by beliefs and reasoning, whereas the Platonic-Aristotelian framework, as understood in this period, assumes a substantive division between rational and non-rational parts of the psyche. Second, Stoicism and Epicureanism presuppose that human beings are all naturally capable of developing towards virtue and happiness. By contrast, the Platonic-Aristotelian view is that ethical development depends on a combination of the appropriate kind of inborn nature, family or communal upbringing, and intellectual education. Elsewhere in his writings (notably in PHP and QAM., ch. 11), Galen underlines these points of contrast and argues strongly for a Platonic-Aristotelian approach on both topics.11 However, in Aff. Dig., Galen’s discussion reflects both approaches, without acknowledging the rather different implications they have for the management of emotions, the scope for change at different points in one’s life and for methods of therapy. Although, in the first part, the Stoic-Epicurean influence is more marked, and in the second part, the Platonic-Aristotelian approach is more evident,12 the distinction is not systematically maintained. For instance, the therapeutic method consistently recommended is rational self-monitoring and conscious self-correction, a method that matches the Stoic-Epicurean approach rather than the Platonic-Aristotelian.13 So, when examined closely, Aff. Dig. exhibits problems of cohesion both in structure and philosophical consistency, despite presenting itself as a unified study of the management of emotions.

On the face of it, Ind. also exhibits problems of structure or organisation of themes, and raises questions about its philosophical coherence. As regards structure, there is an obvious division between the first half, cataloguing Galen’s many losses in the great fire in Rome of AD 162 (1–37) and the second half, which presents themes characteristic of the therapy of emotions (38–84).14 Of course, the two halves are explicitly linked: the overall aim, signalled in the initial address and underlined subsequently, is to explain why Galen was not distressed by losses, detailed in the first half, which would be expected to cause distress, and which caused distress to others.15 Even so, the scale and detailed elaboration of the catalogue of Galen’s losses is quite exceptional, within the genre of philosophical therapy, and it is not obvious why this degree and kind of detail is needed for this purpose. Also, the second half seems to break down, into a number of distinct sections or phases, and the rationale for the ordering of these sections is not immediately clear. The first and last sections (39–48 and 79–84) are centred on a critique of insatiability (aplēstia), the first of which is rather generic (typical of the genre of philosophical therapy of emotions). Another element, rather puzzlingly repeated, is a quotation from Euripides, which was often cited in connection with a well-known method of therapeutic training, the ‘preparation for future evils’, alluded to in Ind. 52–57, 76–7.16 Along with these more standard features of philosophical therapy, we also have, as well as the recollection of the horrors of Commodus’ rule (54–5), the more personal reminiscence of the psychological and ethical influence of Galen’s father (54–68). This incorporates a series of philosophical or quasi-philosophical reflections, presented as underlying Galen’s equanimity in the face of losses (61–68). Another section seems to offer a more pragmatic or qualified version of the philosophical principles just outlined, setting out the minimum standards needed, in Galen’s view, for an endurable form of human life (69–78). Although I think there is an underlying rationale for this set of topics and for their linkage with the opening catalogue of losses, it is easy to form the impression of a rather miscellaneous, even ramshackle, structure.17

One can also question whether there is a coherent philosophical, or at least conceptual, framework. The most densely philosophical section is the resumé of ideas in 61–68, which hovers, rather awkwardly, between reportage of Galen’s father’s advice and Galen’s own, philosophically informed, conclusions. Although this section seems to evoke the ethical positions of various philosophical schools, it is less clear which theories are being evoked and whether the section as a whole hangs together and adds up to an overall framework for maintaining equanimity. The dominant note has sometimes been seen as Aristotelian; but there is a strong case for seeing it as Stoic. However, exactly, we interpret this resumé, we need also to correlate it with the following section in which Galen explicitly distances himself from Stoic and Epicurean ideals of emotional invulnerability from disaster, 69–75. Further, though less obviously, there is the question how the two middle sections in the second half (61–8, 69–78) relate to Galen’s advice on avoiding insatiability, which comes earlier and later (39–48, 79–84).

The difficulty of gauging the structure and conceptual framework just highlighted emerges more strongly if we compare the second part of Ind. with the closely analogous section of Aff. Dig. (V.37 K.–52 K. =25–34 DB). In Aff. Dig., we find similar motifs to those just noted in the second half of Ind.: (1) explanation why Galen shows exceptional equanimity (V.37–38 K. = 25–26 DB); (2) clarification of the respective roles of inborn nature (V.38–40 K. = 26–27 DB), family upbringing (V.41 K. =28 DB), and intellectual education, combined with his father’s advice (V.41–43 K. =28–29 DB); (3) the personal impact of these factors on Galen and his view of the minimum conditions for an endurable human life (V.43–5 K =29–30 DB); (4) a sustained critique of insatiability and correlated commendation of self-sufficiency (autarkeia) (V.46–52 K. =31–34 DB).18 Although the themes themselves are highly comparable in both works, the ampler scale and fuller explication in Aff. Dig. make it easier to discern the overall line of thought. Galen’s main point is that a proper realisation of the misguided character of the emotional force of insatiability, and its corrosive effect on human happiness, is crucial for achieving both self-sufficiency and equanimity in the face or prospect of material losses (V.51–52 K. = 34 DB). However, a crucial prerequisite for grasping this point properly and making it genuinely part of one’s character is the kind of nature, upbringing and education that Galen had. This, presumably, explains the difference emphasised between Galen and his addressee. Although they are both wealthy members of their society, Galen is more ready to spend his income and to do so in a way that benefits others, and is also not worried about money. The addressee is much richer, but also less willing to spend on himself or others, and is also much more anxious, because he is gripped by the insatiable desire to have more money than others, without any need to do so (V.47–51 K. = 32–34 DB). This may also explain the points made subsequently that Galen’s advice to others has been generally ineffective and that in people more advanced in years this vice is too ingrained to be removed (V.53–54 K. =35–36 DB).

Another feature that is clearer in Aff. Dig. is the precise content of the advice offered by Galen’s father (which is cited as direct quotation in V.42–43 K. = 29 DB). In Ind., by contrast, it is less evident what is and is not being ascribed to Galen’s father. The quotation of his father’s view in Aff. Dig. also makes it plain that the paternal advice is neutral between philosophical theories, and is presented as a kind of ‘consensus-position’, shared also by non-philosophers. It is also more apparent in Aff. Dig. that the intellectual eclecticism or independence which is also implied, I think, in Ind. 61–8 (and which is Galen’s typical stance) is the product of his father’s advice.19 Also, Galen here ascribes to his father the account of the minimum level of possessions needed for a life free from distress, namely what is enough to keep one from hunger, thirst or cold, which is presented in Ind. as Galen’s own opinion.20

In the light of the fuller articulation of themes and the clearer specification of the father’s influence, I am inclined to see Aff. Dig. as the later work, and as a reworking (at least in the sections discussed) of similar themes. This dating matches some of the other evidence bearing on this question. The main obstacle to this view of their relative dates is the curious omission of any reference in Aff. Dig. V.44 K. = 30 DB, where more minor losses are noted, to the substantial losses so fully emphasised in Ind (1–37). However, the losses in the fire of 192, even if they had been mentioned, were not enough to cause Galen any real material discomfort or loss of social standing, let alone leaving him hungry or cold (the levels of loss he specifies as really significant in Aff. Dig. V.44 K. =30 DB). Also, although Galen presents himself as exemplary in both works, it is on rather different grounds. In Ind. Galen’s equanimity in the face of his losses is central for the whole work and the therapeutic strategy. In Aff. Dig., shortly after this passage, Galen sets up a contrast between himself and the addressee, in which both are presented as wealthy people, but Galen is willing to use his resources for himself and others, whereas the other man hoards his resources because of the insatiable desire to accumulate property for its own sake (V.48–49 K = 32–33 DB). It may be that Galen de-emphasises his earlier losses in Aff. Dig. because they are not relevant for this specific contrast.21

2 Galen’s De Indolentia: Underlying Cohesion

In the light of this analysis of the latter part of Aff. Dig., I return to Ind., taking up the question whether there is more underlying cohesion than is initially obvious. In fact, I think that the pattern of thought just outlined in Aff. Dig. also forms the organising framework for Ind., both for the second half and also, though less obviously, for the work as a whole. The aim of the quasi-philosophical reflections in 61–68 remains rather puzzling; but the opening catalogue of losses makes good sense in this framework. The core theme emerges most clearly towards the end of the work. The key prerequisite for gaining freedom from distress (alupia) is freeing yourself from ‘insatiability’ (aplēstia), the restless desire for more (especially more material possessions) that afflicts many people, but especially the rich (79–84). A correlative of this advice is recognising what is really needed to make a human life that is free from distress – more precisely, recognising how little is needed to achieve this. Galen spells out several times what is required: namely, an adequate level of bodily and psychological health, combined with enough material possessions to avoid physical discomfort (71–6, 78). However, this minimum level needs to be accompanied by the right mental attitude, which enables one to regard this standard of living as acceptable. Achieving this attitude depends on psychological training, formulated here (77, cf. 52) in terms of a Euripidean passage frequently cited in support of the philosophical therapeutic method of ‘preparation for future evils’.22 As brought out earlier in the work, the effectiveness of this training depends, in turn, on nature, upbringing and education.23 Although this overall line of thought is spelled out most clearly here (in what seems to be signalled earlier as Galen’s ‘second’ explanation for equanimity),24 it also makes sense of the previous part of the second half and also, in a different way, of the catalogue of losses in the first half of the work.

To some extent, the function of the catalogue of losses is made apparent from the start. The work is presented as a letter in response to an invitation ‘to show you what kind of training, what arguments or what considerations had prepared me never to be distressed’ (1).25 Galen’s equanimity in the face of the very extensive losses experienced in the great fire at Rome in AD 162 represents the most striking expression of a fortitude shown by him in earlier losses (1–2). The losses are outlined in 4–6, together with a pointed contrast between Galen’s equanimity and the terminal or funereal despair of others in the same situation (7). This prepares the ground for the promised explanation for Galen’s absence of distress (1) in the latter half of the work (38–84). However, this rationale is not quite sufficient, at least, if we are interpreting the work as a contribution to the philosophical therapy of emotions. The main relevant features of the situation are set out in 1–7. Why then do we need, for this purpose, another 30 chapters cataloguing Galen’s losses in such detail? Admittedly, Galen does not only list losses. He also underlines features that made the losses particularly severe, notably the impossibility of replacing Galen’s, often personally annotated, books (12b–19), losses intensified by the timing, just before Galen sent a substantial number of copied works to Campania (20–29). Galen also concludes the catalogue (30–37) by enumerating a unique collection of drug recipes, of immense value for his medical work, along with many other medical items lost in the fire. While accentuating these very substantial losses, which were items hugely valuable as support for Galen’s intellectual life and his mission as a medical writer and practitioner, Galen stresses, repeatedly, that he was not distressed by their loss (11–12a, 29–30, 37). So it might seem that, even for therapeutic purposes (setting aside any purely autobiographical objectives), the catalogue of losses is fully explained.

However, I think we can see one further salient objective, if we bear in mind the aim of counteracting ‘insatiability’ (aplēstia), apparent at the close of the work (78–84, esp. 80–81). Galen, here and in Aff. Dig., does not simply identify this vice in general terms. He also spells out, often in precise numerical terms, the scale of the desires and ambitions of those afflicted by this vice. He specifies in the same numerical terms the attitudes of those, such as Aristippus, who endured significant losses without distress.26 By the end of the work, we are also in a position to recognise the sharp contrast between these extravagant desires and the minimum level that human beings actually need for a life free from distress (78–84). Galen’s particularised catalogue of his losses (1–37), like the much briefer sketch of Aristippus’ response to his losses (40–42), thus serves as a powerful contrast to those extravagant desires. Whereas insatiability yearns for an ever-increasing amount and plurality of possessions, Galen’s catalogue spells out in graphic detail all that one can live without – while still remaining un-distressed. The catalogue of losses can thus be seen as a complement to the later specification of the minimal conditions needed for a human life free from distress: Galen is saying, ‘look at how much one can live without’, as well as ‘look at how little one can manage with’. From this standpoint, the scale and particularity of Galen’s catalogue serves a therapeutic function (whatever autobiographical function it may also have). The fact that Galen’s list of losses focuses on the destruction of resources for intellectual activity and medical practice, rather than more standard examples of precious objects, is not, perhaps, directly relevant for this broad, moralising point. However, it does illustrate that ‘insatiability’ can take many different forms, not all of which are obviously moral defects. Also, of course, it takes us to the heart of the significance of these losses for Galen. Although this is, on the face of it, a purely personal point, it has significant implications for his therapeutic message explored in the final section of this discussion.

How far does the linkage between aplēstia and alupia, made at the end of the work, together with the parallel with the relevant section of Aff. Dig., help us to make sense of the earlier sections in the second part (38–68) and the overall sequence of thought? The relevance for the opening section of Galen’s explanation for not being distressed (39–48) is clear. Galen’s use of stock anecdotes and exemplars from the therapeutic tradition (especially Aristippus) illustrates the contrast between insatiability and taking a realistic view of what one has, and thus not being distressed by loss, which is articulated more fully later.27 However, Galen also underlines the limitations of this initial, and rather generic, set of exemplars for his purposes. He acknowledges, first of all, the difference between his financial situation and that of some of the philosophical exemplars he refers to (notably, the Cynics Crates and Diogenes and the Stoic Zeno, 45, 48). What was left for Galen was ‘much more than sufficient’ (46). Also, what Galen accentuates was not just his lack of distress at the loss of money or standardly valuable items, but rather the drugs and writings central for his mission in life (50). It was his lack of distress at this loss which constituted ‘a prime display of nobility and nigh on magnanimity’ (50) that needs to be explained. So the opening illustration of the difference between insatiability and realism is marked as only a preliminary move in Galen’s explanation, and his therapeutic strategy.

How is the explanation developed? First, Galen has recourse to another rather standard feature of the philosophical genre, the strategy of preparing for misfortune by anticipating it in your mind, illustrated by the Euripides passage also cited later (52–3, 76).28 He gives this stock item a more personal force – and one which would have resonated strongly with his contemporary readers – by presenting it as his way of coping with the horrors and unpredictability of the rule of Commodus, only just ended (54–6). However, more significant is his next move, a qualification of the usefulness of this method, or, by implication, of the earlier recommendation to avoid insatiability, taken on its own. ‘This prescription cannot be given to those with no natural aptitude for courage or without an excellent education, which a generous fate vouchsafed to me’ (57). This point is developed by reference to Galen’s father, who was naturally exceptional for his ‘justice and self-control’ (58) and who had in turn been ‘trained from childhood in virtue’ (59). Galen spells out the inference: ‘So you may suppose that I am naturally like my forebears because I was born like this and, moreover, because I had an identical upbringing, I have a similar disposition of soul to them’ (60). At this point, as in the comparable section of Aff Dig., Galen signals his adherence to the Platonic-Aristotelian, rather than Stoic or Epicurean, pattern of thinking about ethical development.29 Philosophical strategies, such as ‘preparation for future evils’, and indeed philosophical advice generally, are not enough by themselves to shape character and reactions. They are only effective if grounded on the right kind of inborn nature and childhood habituation, a point underlined by reference to the addressee, who is presented as someone who shares these advantages (51, 57, 79).

However, Galen goes on to outline a number of philosophical principles, and to say that these were (presumably, in conjunction with his nature and upbringing) influential on his state of mind: ‘Brought up in this way of thinking, I always consider these things of little value, so how could I suppose leisure, instruments, drugs, books, reputation and riches to be precious?’ (65) This outline of philosophical ideas and their effect (61–8) is the most problematic part of the work, generating interpretative problems of various kinds. It is difficult, first, to determine whether Galen is reporting his father’s ethical principles or offering his own account of them (or of his own ideas). He begins by reporting them (61–2) and implies in 65 that these were the parental ideals that shaped his upbringing. But in 63–4 he seems to be thinking the ideas out for himself. In 64, he refers to his own views or at least his reflections on certain received views, and in 67 he cites his own opinions and, indeed, ‘logical proof’ of the claims made (67, also 68). A further complication is that, although the passage evokes specific themes in philosophical ethics, Galen says that his father ‘did not consort with philosophers in his youth’ and that his father’s principles were based on his being ‘trained from childhood in virtue’ (59). Hence, the philosophical connotations of the passage, whether presented as reportage of his father’s views or not, must be Galen’s addition. As noted earlier, the comparable Aff. Dig. passage is much clearer in this respect, explicitly quoting Galen’s father’s advice, as well as reporting his commendation of a kind of ‘consensus-position’, shared by many philosophers and ordinary people.30 Although we may think that a similar view is implied here, emerging out of the various allusions to philosophical positions in 61–8, this is not actually explicit, leaving the overall significance rather unclear.

A second problem lies in establishing which philosophical theories are being evoked in the passage, as well as how far these evocations add up to a single line of thought. The most unequivocal allusion is the rejection, first, of vulgar hedonism, and then of the subtler Epicurean view of pleasure (that of ‘being merely free from pain and distress’) as a plausible candidate for being the goal of human life (or the good) in 62. This is reinforced by the subsequent dismissal of the idea ‘that remaining undisturbed’ (aochlēsia) is the good, along with Galen’s reference to his own Against (or On) Epicurus (68).31 The review of principles begins with the striking claim that ‘my father despised human affairs as of little worth, and this is exactly the same for me in my old age’ (61). The rather lofty, ‘god’s-eye’, stance of this passage, may evoke two striking Platonic passages in the Republic (a work Galen knew well), bearing in mind that the whole passage is designed to explain the ‘magnanimity’ (megalopsuchia) with which Galen bore his losses.32 A later passage, referring to Galen as writing, not ‘with zealous enthusiasm or as something tremendous, but simply as a kind of hobby’ (67) seems also to allude to a well-marked Platonic comment on the relatively low value of writing in the Phaedrus.33 In 63–4, Galen gives a prominent place to the idea that the good (or goal of human life) is ‘knowledge of matters human and divine’. Although some commentators have seen this phrase as Aristotelian in provenance,34 Teun Tieleman, writing in this volume, argues strongly that the allusion is to Stoic ideas, since this phrase was a standard formulation for wisdom (the ideal human state) in Stoicism.35 Tieleman links this phrase with the ‘magnanimity’ accentuated in 50–51, pointing out that the relevant sense of this term, namely facing adversities in a courageous spirit, has clear Stoic, rather than Aristotelian, connotations.36 However, Aristotle’s stress on the idea that the goal of life must be an activity not a state may be alluded to in the final comment in the passage, criticising the Epicurean ideal of ‘remaining undisturbed’ (68).37

Even if we are confident about charting these allusions, there remains the problem of making sense of the overall line of thought in the passage, taken in the context of the work as a whole. One approach worth considering is a broadly Stoic reading, building on Tieleman’s interpretation of the connotations of the terms. The underlying line of thought would be some version of the Stoic claim that happiness depends wholly on virtue, and that ‘external things’ such as material goods and reputation are, relatively, ‘matters of indifference’.38 The Stoic conception of magnanimity as fortitude in the face of disaster reflects this general view, as does their belief that possession of virtue brings with it inner peace of mind, regardless of external circumstances (ideas that figure prominently in Stoic or Stoic-influenced therapeutic writings).39 On this reading, Galen interprets his father’s adherence to virtue (‘justice and self-control’, 58) primarily in Stoic terms. This would explain Galen’s conclusion that ‘external things’ such as ‘leisure, instruments, drugs, books, reputation and riches’ are ‘of little value’, that is, in more technical Stoic terms, they are only, at most, ‘preferred indifferents’ (65).40 In support of this view is the prominent role played elsewhere by the Euripidean passage linked with the strategy of ‘preparation for future evils’, which was recognised as a Stoic, rather than Epicurean, method, though it was not peculiar to them.41 As so interpreted, Galen’s exceptional equanimity concerning his great losses in the fire would be explained, primarily, in Stoic terms.

Although this interpretation is coherent, and matches some points in the text, I do not think it is, in the end, tenable. A rather obvious problem is that in 63–64, Galen adopts a very guarded or cautious attitude towards this ideal, or at least towards putting it into practice. Galen’s wording and line of thought is particularly murky here.42 But the main point seems to be that it is very difficult to gain ‘knowledge of human and divine affairs’ (the Stoic account of the human good) with sufficient understanding to put it into practice. In fact, the Stoics do believe that wisdom, the human ideal state, is very hard, even virtually impossible, to achieve fully, though they also maintain it is the appropriate target for everyone; and this combination of ideas was often cited by critics of Stoicism as self-contradictory or at least problematic.43 Galen perhaps has that criticism in view here. He connects this point with a guarded attitude towards engaging in politics, because of its inherent difficulty and the fact that most people are not in fact helped even by genuine efforts in their behalf (64). The link between the two ideas in 63–4 is not obvious. But it may be significant that the Stoics were well-known for maintaining that the wise man (the paradigm for all of us) should, in principle, engage in political life, by contrast with the negative Epicurean attitude towards political involvement.44 So Galen may be dissenting at this point from two standard features of the Stoic ethical ideal. A further problem for taking 61–8 as marking Galen’s adoption of a Stoic approach is that this would run counter to the explicit repudiation of the Stoic (or Epicurean) ideal of invulnerability in 71–75, and the earlier presentation of Zeno’s response to misfortune as ‘amazing’ and well beyond Galen’s own (48, cf. 46).45

How, then, does 61–68 contribute to Galen’s therapeutic strategy in Ind. as a whole? Overall in Ind., Galen explains his exceptional equanimity in the face of his losses (his alupia) by his having counteracted any tendency towards insatiability (aplēstia). Crucial in this respect is forming a realistic picture of the minimum needed to maintain a human life free from distress, namely an adequate level of physical and psychological health supported by enough material possessions to avoid pain and discomfort. Galen has also prepared himself for any such eventuality by dwelling on this prospect in advance, especially during the reign of Commodus, when exile and loss of all one’s possessions were daily prospects (54–55) – that is, situations much worse than he actually experienced. There remains the question how Galen mustered the inner, psychological or ethical, resources (the ‘magnanimity’, 50–51) to embrace this tough-minded approach to life. This is explained primarily in terms of his inborn nature and upbringing, and the adoption of the (un-theorised) ethical principles of his father and forefathers (59). Although these principles are expressed (or ‘glossed’) in terms that evoke specific philosophical ideals, Galen does not identify the principles adopted in terms of any one philosophical framework. Indeed, he explicitly rejects some philosophical ideals (Epicurean ones, 62, 68) and is guarded regarding the achievability of others (Stoic ones, 63–4). The positive element, which is not qualified, is a kind of high-minded indifference to circumstances (or indeed ‘human life’, 61) that Galen sees as enabling him to regard the things lost as ‘of little value’ (65) and hence to be free from distress at their loss. What emerges, overall, is not the conception of virtue or the good life (happiness or eudaimonia) espoused by any specific theory but, rather, a broadly, ‘philosophical’ view of life that can support the quality of character, the virtue (‘magnanimity’) that enables Galen to maintain a realistic view of the scale and importance of his losses. On this view, the resumé of philosophical ideas in 61–68 makes a relatively modest contribution to the overall line of thought, compared with the contribution made by the theoretical framework in more doctrinally focused works of ancient (especially Stoic and Epicurean) therapy of the emotions.46 But the contribution is one that is consistent with the overall shaping and line of thought of the work: and this helps us to recognise that Ind., taken as a whole and closely examined, has its own coherence and distinctiveness, exceptional though it is in the genre in which it figures.

3 Was This the Whole Truth?

I end this discussion by raising a different, though related, question. Was Galen’s explanation for his equanimity actually true – or at least, was it the whole truth? Assuming that he did indeed show exceptional equanimity in this situation (of course, we only have his word for this),47 does this explanation ring true in the light of what we know about him from other sources?

Let us briefly call to mind what most of our evidence suggests about Galen’s character. He was an utterly driven, obsessive, hugely ambitious, medical practitioner, thinker and writer whose core project in life was to become, and remain, the world-leader in his field.48 In the first half of Ind., his account vividly underlines the threat to this aim from the losses of medical handbooks, recipes, collections and so on in the great fire (5–6, 12a, 29–37). I strongly suspect that what enabled his equanimity in the face of these losses was the confidence that he still had the resources, energy and determination (despite his age, about sixty-three) to maintain and take further this core project. If this was what he felt, he was right, as it turned out; he did rewrite lost works, gather missing resources, and produce more medical writings, though not perhaps on the same scale as before, until his death about seventeen years later.49 Of course, in 193, when he seems to have written the work,50 he could not have known that he would be able to continue his career in this way. But he had reasonable grounds for thinking he could do so; and this was, I guess, a key factor, and perhaps the key factor, underlying his absence of distress.

However, if I am right in suggesting this, the obvious further question is this: why did he not say so in Ind., which claims to offer the explanation for his equanimity? It is also perhaps surprising, from this standpoint, that, in the section of Aff. Dig. (V.44 K = 30 DB) dealing with his response to losses (though not his losses in the fire of 192), he also does not cite this factor explicitly.51 However, here he comes closer to bringing out this side of his motivation. He makes it clear that at all stages of his life so far he has had ample financial resources and that he feels committed to using these to benefit others, following his father’s advice and example. This can plausibly be taken as an allusion to his exceptional social contribution as a medical practitioner and writer, which depended on using his considerable personal wealth for this purpose. As suggested earlier, Galen’s self-presentation in this passage forms part of his therapeutic guidance, showing how his characteristic freedom from distress is linked with his freedom from insatiability.52 However, if this passage at least allows the possibility of the kind of explanation I am suggesting, this raises still more acutely the question why this explanation is entirely missing in Ind.

In considering this question, it is worth noting that this explanation is not only absent from Ind., but is actually ruled out by the line of thought presented there. The catalogue of losses, as noted earlier, gives special attention to the loss of medical books and resources, as factors which might have made Galen especially distressed – but which did not in fact do so.53 Also, the philosophical section in 61–8 excludes this option in two ways. In 64 Galen discounts the idea that aiming to help many people by one’s earnest endeavours can, on a realistic view, provide the basis of a human life free from distress (because most people cannot reliably be helped in this way). In 65, he stresses that his upbringing made it inconceivable that he could regard ‘drugs, books, and reputation’ as precious, although these are things that we might well suppose were precious to Galen in his role as world-famous doctor. Also, while acknowledging in 46 that even after the losses, ‘what was left was more than sufficient’, and thus, by inference that this allowed the renewal of his medical role, his account of the minimal conditions for a life free from distress falls far short of this level. Indeed, Galen there presents himself as happy ‘to talk with a friend and to follow what is being read by someone to me’ (78). He presents himself as an amiable, if slightly doddery, old man: a picture very different from that of the still active and forceful individual we might reasonably reconstruct from Galen’s medical and other writings in the later part of his life.54 This is also a self-presentation which runs counter to the view I am proposing, that Galen was heartened in his losses by the prospect of engaging fully again in his medical objectives.

To put the point more generally, the therapeutic strategy Galen adopts in Ind, rules out reference to the explanation which I am suggesting may have underpinned his equanimity. In focusing on the idea that the key to alupia lies in counteracting aplēstia, especially by recognising the minimum needed for a pain-free life,55 Galen set up a framework in which the retention of a specific life-mission had little room. Indeed, it would have run counter to this therapeutic approach, since it would have placed weight on factors (material resources, medical supplies and books, intellectual energy and stamina) that Galen here insists are not prerequisites for a life free from distress. So I think this explanation does not appear for this reason – which is not to say it was not, in reality, part of his response at this time. A further question, then, is why he adopted a therapeutic strategy which ruled this possibility out. Galen could have found, for instance, in Stoic thought, support for the idea that one can be sustained in one’s losses, which can include loss of loved ones as well as possessions or even your own life, by renewing or continuing one’s commitment to a life-project. This set of ideas figures as part of a therapeutic strategy in Seneca’s On Peace of Mind, for instance, and appears also in Epictetus’ Discourses and Marcus Aurelius’ Meditations.56 Of course, Galen might not have been aware of this line of thought, though he seems to have a good knowledge of the philosophical therapeutic tradition. He might also have had reservations about adopting a strategy that was so closely linked with Stoicism, although Aff. Dig. shows a good deal of influence from Stoic therapeutic writings.57 In any case, this was not the strategy he chose to adopt, in Ind. or in the comparable part of Aff. Dig.; and the explanation for his equanimity that I am proposing did not fit the strategy he did adopt. However, this does not mean it was not part of his actual experience – though we may never be able to prove this.58


Texts and Translations Used

  • De placitis Hippocratis et Platonis. Ed. with translation and commentary P. De Lacy. Corpus Medicorum Graecorum V.412. Berlin: Akademie1978–84rev. edn. 2005.

  • Galen. Oeuvrestome IV: Ne pas se chagriner. Eds. with translation introduction and commentary V. Boudon-Millot and J. Jouanna with the collaboration of A. Pietrobelli. Paris: Les Belles Lettres2010 (= BJP).

  • Galen. De propriorum animi cuiuslibet affectuum dignotione et curatione; De animi cuiuslibet peccatorum dignotione et curatione. Ed. W. De Boer. Corpus Medicorum Graecorum V.4.11. Leipzig/Berlin: Akademie1994 (= DB).

  • Galen. Psychological Writings. Ed. P. N. Singer translated with introductions and notes by V. Nutton D. Davies and P. N. Singer with the collaboration of P. Tassinari. Cambridge: Cambridge University Press2013.

  • LongA. A. and SedleyD. N. The Hellenistic Philosophers. Cambridge: Cambridge University Press1987 (= LS).

  • SharplesR. W. Peripatetic Philosophy 200 BC to AD 200: An Introduction and Collection to Sources in Translation. Cambridge: Cambridge University Press2010.

See also, on περὶ ἀλυπίας, as philosophical therapy, Gill, C. (2010), Naturalistic Psychology in Galen and Stoicism, 262–68; Galien tome IV: Ne pas se chagriner, eds. V. Boudon-Millot et al. (2010) (=BJP), xxxix–lviii; Nutton, in Galen, Psychological Writings, ed. Singer (2013), 61–68; Kaufman, D. H., ‘Galen on the Therapy of Distress and the Limits of Emotional Therapy’, Oxford Studies in Ancient Philosophy 47, 2014, 275–96; Xenophontos, S., ‘Psychotherapy and Moralising Rhetoric in Galen’s Newly Discovered Peri Alypias’, Medical History 58.4, 2014, 585–603. The present discussion focuses on the question of coherence more than these other treatments, with the exception of Kaufman, ‘Therapy’, who discusses this question in 276–89. On interpretation of Ind., see also the essays in Rothschild, C. K. Thompson, T. W. (eds.), Galen’s De Indolentia, 2014.

On the earlier history of the genre, see Laín Entralgo, P., The Therapy of the Word in Classical Antiquity, 1970; Gill, C., ‘Ancient psychotherapy’, Journal of the History of Ideas 46.3, 1985, 307–25, esp. 320–25.

See Gill, Naturalistic Psychology, 246–300, on Galen’s two works in the context of the genre; also, on Hellenistic-Roman philosophical therapy, Hadot, I. (1994) Seneca und die griechische-römische Tradition der Seelenleitung; Nussbaum, M. C. (1994). The Therapy of Desire; Sorabji, R. (2000). Emotion and Peace of Mind, esp. chs. 11–17.

English titles as in Galen, Psychological Writings. Abbreviations of Latin titles of Galen’s works as in Hankinson, R. J. (2008). The Cambridge Companion to Galen, 399–403.

On Galen as author of both medical and ethical writings (though not combining the two approaches), see Singer, general introduction in Galen, Psychological Writings, 10–15, 26–30; also Gill, Naturalistic Psychology, 300–29. See also Gill, C. ‘Philosophical psychological therapy – did it have any impact on medical practice?’ in Thumiger, C. and Singer, P. N. (eds) (2018), Mental Illness in Ancient Medicine, 365–80.

For a reconstruction of Chrysippus’ therapeutikon, see Tieleman, T. (2003). Chrysippus’ On Affections: Reconstruction and Interpretation, 140–97, 326; also Gill, Naturalistic Psychology, 280–95.

On links between Plutarch’s peri euthumias and Gal. Ind., see BJP, x–xi, xl–xli. On the philosophical approach of Plutarch’s essays, see Gill, C. ‘Peace of Mind and Being Yourself: Panaetius to Plutarch’, in Haase, W. and Temporini, H. (1994). Aufstieg und Niedergang der römischen Welt II.36.7, 4599–4640, esp. 4624–31, Naturalistic Psychology, 250–1; Van Hoof, L. (2010). Plutarch’s Practical Ethics, ch. 4.

See Gill, C. ‘Philosophical Therapy as Preventive Psychological Medicine’, in Harris, W. (ed) (2013). Mental Disorders in the Classical World, 339–60, and refs. in n. 3.

See text to nn. 18–21.

Gal. Aff. Dig. V.1, 13–14; 37, 48–51 K. = 3, 11; 25, 32–34 DB. See also Singer, introduction to Aff. Dig., in Galen, Psychological Works, 218–19.

See Gill, Naturalistic Psychology, 214–29.

See e.g. V. 4–5, 7, 16–17, 24 K. = 5, 7, 12–13, 17 DB) (Stoic-Epicurean view: all or most emotions/passions, pathē, are psychological sicknesses or forms of ‘madness’ to be cured or extirpated, and ethical progress can be correlated with this process); V. 27–34 K. = 19–23 DB (Platonic-Aristotelian view: distinction between ‘education’, paideusis, and ‘disciplining’, kolasis, and stress on ‘habituation’, coupled with distinction between rational and non-rational parts of psyche).

Methods recommended are sustained self-scrutiny, using a critical adviser, adjusting your ideas about what you really need: see e.g. V.6–7, 8–14, 20–21, 51–3, 55–6 K. = 6, 7–11, 15, 34–35, 36–37 DB. See Gill, Naturalistic Psychology, 252–62; also Singer, introduction to Aff. Dig., in Galen, Psychological Writings, 220–28. However, Hankinson, R. ‘Actions and passions’, in Brunschwig, J. and Nussbaum, M. C. (eds), Passions and Perceptions, 1993, 198–204, sees Galen’s approach in Aff. Dig. as more coherent.

Numbers of sections in Ind. as in BJP (2010) and Galen, Psychological Writings, 2013.

See text to n. 25.

Euripides fr. 814 Mette = fr. 94 Nauck; also cited in Gal. PHP V.418 K. = De Lacy 282.17–23, [Plu.] Consol. Ad Apoll. (Moralia) 112 D, and (in Latin), Cic. Tusc. 3.29. It was regularly cited in connection with the therapeutic strategy of ‘preparation for future evils’, recommended by both Cyrenaics and Stoics; see Cic. Tusc. 3.28–31, 52; also Tieleman, Chrysippus, 311–14, Gill, Naturalistic Psychology, 290, BJP, 139–42.

On this whole sequence of topics, see BJP, xxix–lviii.

On these similarities, see also BJP xlv–xlix, lv–lviii; Nutton, introduction to Ind. in Galen, Psychological Writings, 65–66; Xenophontos, ‘Psychotherapy’, 2014, 598–600.

See para. including n. 46. See also Hankinson, R.J. ‘Galen’s Philosophical Eclecticism’, in Haase, W, and Temporini, H. eds, Aufstieg und Niedergang der römischen Welt, II.36.5, 1992, 3502–22. On Galen’s philosophical eclecticism in Ind., see also Kaufman, ‘Therapy’, 286–7, and the appeal to his father’s authority, ‘Therapy’, 291.

Aff. Dig. V.44 K. = 30 DB: Ind. 78.

On the dating question, see Nutton, introduction to Ind. in Galen, Psychological Writings, 2013, 45–48, which I follow, by contrast with BJP, lviii–lxi, which places Aff. Dig. before Ind. The fact that Galen presents himself in Therapeutic Method, probably written in the late 190s (i.e. later than Ind. or Aff. Dig.) as intensely distressed for long periods (MM X.456–457 K.) (cf. Nutton, ibid. 67) suggests that Galen’s self-presentation is often shaped for the needs of the context of writing. On Galen’s self-presentation and authority, see Xenophontos, ‘Psychotherapy’, 2014, 590–93.

See n. 16.

See Ind. 79, also 51, 57, 65. In these passages, by contrast with Aff. Dig. V.48–52 = 32–4 DB, Galen stresses the similarity of character between himself and the addressee. See also on this point Kaufman, Therapy, 2014, 292–3.

I take it that Ind. 70–83 amplifies the explanation said to be complete in 69, and thus provides the ‘second’ explanation signalled in 39.

Translations taken from Galen, Psychological Writings, 2013. For an alternative English translation, see Rothschild, C. K., Thompson, T. W. (eds.), Galen’s De Indolentia, 2014.

Ind. 41–48, esp. 42–43, 45, 47, also 83; Aff. Dig. V.46–47, 49 K. (=31–32, 33 DB); see also BJP lv–lviii.

Ind. 43, 45, cf. 80–2 (also 71–5, 78). The Aristippus anecdotes appear also in Diog. Laert. 2.77, Plut. peri euthumias (Mor.) 469 C–D.

See n. 16. Kaufman, ‘Therapy’, 2014, 281–4, stresses the importance of this theme in Galen’s therapeutic strategy in Ind.

See text to nn. 11, 18. Kaufman, ‘Therapy, 292–3, also underlines this point.

See text to nn. 19–20. As noted there, in Aff. Dig., the specification of a minimum level of life is presented as part of Galen’s father’s advice (V.44 K. = 30 DB), whereas in Ind., this appears as a subsequent qualification by Galen of the philosophical ideas, which are linked (though loosely) with his father (71–5, 78).

For the Epicurean ideal, see Long, A. A. and Sedley, D. N., The Hellenistic Philosophers 1987 (= LS) (refs. to sections and passages), 21 A–B. The ideal of ‘remaining undisturbed’ is also associated with other thinkers, including the Peripatetic Hieronymus of Rhodes (BJP, 162), but Epicurus seems to be meant here.

See Republic 486a: the world-view of the ‘philosophical nature’ is characterised as including the kind of ‘magnificence’ (megaloprepeia) that makes one regard human life as nothing great (mega); 604b–c: the rational response to misfortune includes seeing human life as not ‘worth great seriousness’ (axionmegalēs spoudēs).

Phaedrus 276c–e, philosophical writing (as opposed to oral dialectic) should not be done as something worthy of seriousness (spoudē) but as a ‘hobby’ (paidia), 276c7, d3, e1, 5. Galen refers to both Platonic works (esp. Republic) a good deal, esp. in PHP: see Galen, PHP, ed. P. De Lacy, vol. 3, 831 (index locorum). The comment is sometimes taken (BJP, 161) as referring to Galen’s writing specifically about ethics (‘each of these things’, 67), as opposed to medicine; but, bearing in mind his previous dismissal of the importance of ‘instruments, drugs, books’ in 65, his comments, like Plato’s, may apply to writing in general.

Nutton, in Galen, Psychological Writings, 94, n. 104, cites Arist. Met. VI.1, 1026a18–32, XI.7, 1064b1–4; BJP, 156–7, also see Aristotelian influence but offers no refs.

See e.g. SVF 2.35, 36, also 3.362. See also Brouwer, R. (2014), The Stoic Sage, 8–41.

See e.g. Cic. Off. 1.15, also SVF 3.264, 265; contrast Arist. Eth. Nic. 4.3.

Arist. Eth. Nic. 1098a5–18, 1098b30–1099a7. On this theme in later Peripatetic thought, see Inwood, B., Ethics after Aristotle, 2014, 69–70, 109–10; see e.g. Cic. Fin. 5.55–57 (based on Antiochus, an Academic influenced by Peripatetic ideas).

LS 58 and 63.

See e.g. Cic. Off. 1.66–69, Cic. Tusc. 5.40–1, 81–2, Sen. Tranq. 11, 14, 16; see Gill, ‘Peace of mind’, 4609–10, 4615–16, 4621–2.

See LS 58; also Xenophontos, ‘Psychotherapy’, 2014, 596.

See n. 16. According to Cic. Tusc. 3.32–3, Epicureans favoured, rather, averting the mind from bad things.

See BJP, 156–7.

See Brouwer, Stoic Sage, ch. 3.

See e.g. Cic. Fin. 3.66, 68, LS 67 W(3); for the Epicurean view, see LS 22 D(1), S.

See Gill, Naturalistic Psychology, 264–65. This rejection of an extreme standard of invulnerability may also have philosophical echoes: there is a strong vein in Platonic-Aristotelian thought underlining the importance of bodily health and (some) external goods for happiness, often linked with dissent from the Stoic position; see Sharples, R. Peripatetic Philosophy 200 BC to 200 AD, ch. 18. BJP, liv–lv, links Ind. 73 with Crantor (4th/3rd BC Academic), referred to in Cic. Tusc. 3.12, whose position was often cited as part of this strand of thought. However, Galen presents this as his own view.

For a broadly similar interpretation of Galen’s line of thought in Ind., see also Kaufman, ‘Therapy’, 276–89. Contrast Chrysippus’ ‘therapeutic’ book, on which see Tieleman, Chrysippus, ch. 4. But works such as Plut. peri euthumias are more comparable; see also Gill, Naturalistic Psychology, 250–1.

See n. 21.

This comes out clearly in Mattern, S., The Prince of Medicine, 2013, esp. chs. 2, 5, 7. See also Hankinson, R. J. ‘The man and his work’, in Hankinson, R. J. (ed), The Cambridge Companion to Galen, 2008, 23–4; Boudon-Millot, V. ‘Galen’s Bios and Methodos’, in Gill, C. et al. (eds) Galen and the World of Knowledge, 2009, 175–89, on Galen’s view of his medical mission in life.

On his medical writings after the fire, see Hankinson, ‘Man and work’, 22–3; Mattern, Prince, 274–7.

See Galen, Psychological Writings: Singer, general introduction, 39–41; Nutton, introduction to Ind., 45–8.

Also, of course, since Galen does not cite his losses in the fire in Aff. Dig., it would be inappropriate to refer to this explanation for not being distressed by the losses.

See text to nn. 18, 21.

Ind. 5–6, 10–12a, 31–8.

On his writings after the fire, see n. 49. Kaufman, ‘Therapy’, 284–6, reads this passage (78) as having more positive content, and evoking Epicurus’ famous death-bed letter (D. L. 10.22) and the Epicurean therapeutic strategy of avoiding pain by redirecting one’s attention to more pleasant things (Cic. Tusc. 3.32–3); but I am not persuaded that this short and unemphatic passage carries these larger connotations.

See paras including nn. 22, 46.

See Gill, ‘Peace of Mind’, 4609–10, 4614–24, 4627–31; Epict. Diss. 1.1–2; on Marcus (whose approach reflects earlier Stoic ideas), see C. Gill. Marcus Aurelius, Meditations Books 1–6, xlix–lii.

See Gill, Naturalistic Psychology, 253–5.

This paper has gained from the stimulating discussion at the Warwick conference. It has also benefited from helpful comments made after two papers I gave on Galen’s therapeutic writings given in Berlin, at the Topoi Exzellenzcluster and Humboldt University; special thanks to Philip van der Eijk and Roland Wittwer for organising these sessions.

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