Part II - Case Studies

Chapter 4 Avoiding Distress

Mortals have no other medicine for distress

Like the advice of a good man, a friend

Who has experience with this sickness…

(Οὐκ ἔστι λύπης ἄλλο φάρμακον βροτοῖς

ὡς ἀνδρὸς ἐσθλοῦ καὶ φίλου παραίνεσις.

ὅστις δὲ ταύτῃ τῇ νόσῳ ξυνὼν ἀνὴρ…)

Euripides, fragm. 1079; Kannicht, TrGF vol. 5, p. 1010

The man who is sick in the body needs a doctor;

Someone who is sick in the soul needs a friend;

For a well-meaning friend knows how to treat distress.

(Τῷ μὲν τὸ σῶμα διατεθειμένῳ κακῶς

χρεία ᾽στ’ ἰατροῦ, τῷ δὲ τὴν ψυχὴν φίλου·

λύπην γὰρ εὔνους οἶδε θεραπεύειν φίλος.)

Menander, fragm. 865; PCG vol. VI 2, p. 409

The unexpected discovery of the Vlatadon 14¹ in 2005 brought to light Galen’s long-lost treatise Avoiding Distress.² This text is part of Galen’s ethical writings,³ as seen above, and offers a magnificent testimony to the therapy of lypē in the ancient world.⁴ When giving advice on the treatment of this same passion in one of his medical works, the Therapeutics to Glaucon, Galen suggests introducing the patient to the direct opposite of the condition that troubles him (πειρᾶσθαι δὲ καὶ τὸ ἐναντίον ἀντεισάγειν ἀεὶ τῷ λυπήσαντι), meaning in this case treating him with ‘gladness of heart (θυμηδίαν) in words, deeds, sights and descriptions’ (MMG 1.3, XI.16.5-9 K.).⁵ This sort of distraction therapy, grounded in allopathy,⁶ a mainstay of Galenic therapeutics for both bodily and mental disturbances, is not like most of the advice Galen offers in Avoiding Distress.⁷ And that is a primary indicator that in this work our author steps away from the role of the therapist, who alleviates mental disorder through psychotherapeutic protocols that would have been beyond the ken of non-medical experts. By contrast, he puts on the mantle of the ethicist, who instructs on the management of everyday emotions through philosophical means accessible to all.

Avoiding Distress has been the subject of a large amount of learned commentary, because it provides valuable information about the production and publication of ancient books and the holdings of Imperial libraries.⁸ Others have considered it an important source for adding to our knowledge of Commodus’s cruel regime (180–192 AD)⁹ or because it elucidates aspects of Galen’s life, which we can use as a control on the unreliable Arabic biographies.¹⁰ Finally, some other studies have yielded valuable insights into Galen’s philosophical allegiances, particularly in connection with the tradition of ethical writing, but they tend to limit themselves to identifying philosophical positions and arguments, largely neglecting the literary and rhetorical strategies through which Galen’s project on emotional resilience is realised in the text for the moral benefit of the reader; at best these issues are treated in piecemeal fashion.¹¹

The aim of this Chapter is to examine Avoiding Distress as a holistic literary composition. To that end, it will focus on its content, internal structure and narrative setting, in order to bring out the distinctive characteristics of Galenic ethics and evaluate how it worked and the impact that it seems Galen hoped it would have on contemporary society. This Chapter also seeks to demonstrate that Avoiding Distress is a unique source in respect of Galen’s identity as an ethical adviser and, similarly, in respect of the sophisticated devices he puts in place to promote his moral didacticism. Some of the key topics to be addressed are Galen’s departures from other moralists who have treated the issue of distress (notably Seneca, Epictetus and Plutarch) and the extent to which Galen’s moralism is informed by the (rhetorical) methods he applies in his medical accounts directed at the treatment of the body. Moreover, given that Galen’s Avoiding Distress is the only extant work peri alypias,¹² it may help us to get some idea of the potential content of other, now lost, essays on this topic.

Generic observations and individual features

Avoiding Distress is a letter-essay in response to a request from an anonymous friend.¹³ The correspondent is astonished at Galen’s moral fortitude in the face of the calamity of the great fire on the Palatine Hill in Rome in 192 AD and is eager to find out the philosophical mechanisms that allowed him to maintain his self-control.¹⁴ The dating of the treatise to the early months of 193 AD shows how the recollection of the disaster would have still been fresh in people’s minds – a revived reality, as I shall argue – for both writer and addressee.¹⁵

The thematic framework makes it clear from the outset that this is an essay with moralising intent, belonging to the popularised genre of practical ethics.¹⁶ In referring to more specific typological distinctions between works of ethical philosophy, Philo of Larisa (158–84 BC), once head of the Platonic Academy, established a threefold categorisation: a) protreptic works guiding towards morally adept attitudes and encouraging therapy, b) therapy applying philosophical guidance to particular cases of the treatment of emotions by eliminating false beliefs and c) advice proposing lifestyles through which happiness could be achieved by means of some therapy that has already been applied.¹⁷ It is in the category of ‘therapy of emotions’ (b) that Avoiding Distress best fits, though it may also intersect with the protreptic (a) and the advice on appropriate lifestyles (c), issues to which I will return in the main part of this Chapter. On the other hand, the essay’s prescription for achieving freedom from lypē has led some scholars to associate it with the genre of the consolation,¹⁸ from which, strictly speaking, Avoiding Distress differs in a number of respects. Firstly, it does not involve the loss of a loved one or (a less frequent subject) exile as the cause of the distress, but rather material deprivation; secondly, it is not addressed to a person who is currently mourning some loss, but to a philosophically minded enquirer seeking remedies for regaining equanimity in case of need.¹⁹

What renders Avoiding Distress rare among mainstream works of practical ethics is that the moral instruction professed is enhanced throughout with autobiographical touches that result in a lively sort of moralising.²⁰ The therapy on offer, visualised through a very personal lens, helps consolidate Galen’s authority as a moralist, because it shows that his prescriptions are based on advice that has already been tested and proved successful. On another level, the tranquillity that Galen (as narrator and author) embraces, as opposed to the expected feeling of perturbation, puts him in position to manipulate his audience’s emotional responses during the process of reading, as we shall see.²¹

The construction of authority in the preface, Or how to become a moral hero

In the preface of an epistolary tract the author traditionally mentions the motive for composing his work. The Galenic narrator (or ‘Galen’) starts by claiming that his correspondent’s letter had requested information on the kind of training, arguments and considerations that had made Galen immune to distress. The choice of letter form helps to underline how the core message of the treatise (how to achieve immunity from distress) responds to the psychological needs of its addressee, and so exemplifies what is, in Christopher Gill’s analysis, one of the salient features of ancient therapeutic writing.²² Whether we see the work’s form as a literary convention or indeed an element of the core strategy of the therapeutic genre in line with Gill, it also has implications for Galen’s claim to expertise in practical ethics. I find it striking that, in reproducing the content of his friend’s letter, ‘Galen’ chooses to disclose only some specific points.

According to ‘Galen’, the friend had himself been present and had observed (ἑωρακέναι, Ind. 1, 54.3 PX; cf. ἑωρακέναι, Ind. 1, 54.6 PX) Galen’s tranquillity when the latter lost his slaves in the Antonine plague. Additionally, he had heard (ἀκηκοέναι, Ind. 1, 54.4 PX) that Galen had suffered from similar setbacks in the past. The narrator also tells us that his correspondent now had a clear appreciation of the losses caused by the fire (αὐτὸς ἔφης ἐπίστασθαι, Ind. 1, 54.9-10 PX) and that an informant had told him (πεπύσθαι δέ τινος ἀγγέλλοντός σοι, Ind. 1, 54.10 PX) that Galen was not grieved but was cheerfully continuing his normal activities.

The verbal forms of observation and cognition reinforce the credibility of Galen’s account. His claim to have retained his equanimity in the face of a range of distressing events is backed up by external evidence, by trusted third parties who had personally encountered him and now provided objective reports.²³ Galen’s management of distress attracts the attention of those around him and leads to his being seen as a moral exemplar. The process whereby Galen is elevated to this status begins with the narrator’s detailed enumeration of his losses, itemised in ascending order from the relatively minor to the more substantial, thus stressing the degree of deprivation. He lists many gold and silver plates, but also his drugs (both simple and compound) as well as his medical instruments; then, the editions of ancient authors he had prepared and his own compositions; finally and most importantly, a rare collection of antidotes, among which the famous ‘theriac’ and cinnamon which Galen possessed a very great deal of at a time when it was extremely difficult to get hold of them (Ind. 1, 54.11-56.24 PX).

By confronting the destruction of those treasures with imperturbability, Galen excites his correspondent’s amazement (θαυμάζειν, Ind. 1, 54.11 PX). Amazement leading to admiration of a moral exemplum was a basic component of moral learning in the history of ethics, forming ‘a responsive stage of arousal’ before the ‘next active stage of emulation’, cognition and discernment.²⁴ In context, amazement supports Galen’s claim to moral heroism and his self-projection as a paragon of magnanimity to other people. Αs Galen, drawing on Chrysippus (fragm. 876 SVF), explains in Affected Places, magnanimity makes its practitioners rise far above lypē and other fiercer passions, because their mental strength (τόνος τῆς ψυχῆς) is greater than their passions, which are insignificant (τὰ παθήματα σμικρά, Loc. Aff. 5.1, 288.28-290.3 Brunschön = VIII.302.2-5 K.). The same passage sets the magnanimous individual (ἀνὴρ … μεγαλόψυχος) apart from other people who, by contrast, can die of lypē (ἔνιοι καὶ διὰ λύπην ἀπέθανον Loc. Aff. 5.1, 288.27-28 Brunschön = VIII.302.1 K.).²⁵ This brings to mind Aristotle’s view that magnanimity is a virtue for the few, being an ‘adornment of the virtues’ (Nicomachean Ethics 1124a1). The distinction between people who are magnanimous and those who are not, found in Affected Places, seems to inform the intertext in Avoiding Distress, since the magnanimous Galen is here contrasted with Philides the grammarian (about whom the correspondent had also been informed, πεπύσθαι, Ind. 1, 56.24 PX): facing the loss of his books in the same fire, Philides subsequently died of depression,²⁶ surrounded by black-clad mourners (Ind. 1, 56.27-28 PX).²⁷ The death scene is juxtaposed to the joyful countenance (φαιδρόν, Ind. 1, 54.10 PX) with which Galen withstood the distress described above and this ultimately endorses his suitability to write a treatise on cheerfulness and the treatment of distress.²⁸

Another key issue arising from the proem concerns the role in the text of the addressee, who is meant to participate not just as a witness to the loss of Galen’s material goods, but also because of his personal rapport with the narrator. By reconstructing the addressee’s letter, the Galenic narrator offers a clear glimpse of how the two men share common reminiscences and explains that their epistolary communication thus advances the exchange of knowledge and ideas. Later on in the text the close relationship between the two men is reflected in the description of the social credentials of Galen’s friend, which so much resemble his own: he is a fellow Pergamene, of the same age as Galen (i.e. both now in their mid sixties), they have known each other from childhood, attended school together and enjoyed the same liberal education (ἐξ ἀρχῆς συναναστραφεὶς καὶ συμπαιδευθείς, Ind. 12, 78.2-3 PX; σὺ παιδευθεὶς σὺν ἡμῖν, Ind. 13, 80.5 PX). Having spent some time in Rome, the friend embraces Galen’s political perspective on Commodus’s politics (Ind. 12, 78.16-80.20 PX) and, although they now live miles apart, they have maintained a close friendship for many years.²⁹ Therefore Galen’s personal misfortune is expected to be a familiar matter to the addressee, making its recollection and the quest for ethical equilibrium also something that concerns both of them. Galen is not a distant, bookish preacher, but an intimate and pragmatic moral advisor.

The deliberate introduction of personality into the narrative might be explained in the light of Galen’s moral programme in his Character Traits: the aim of the virtuous person is to reform his own soul in order to reform the souls of all the other people over whom he has influence, one by one, beginning with those closest to him. This he will achieve by teaching them by precept what they ought to do and by making himself a role-model for them (De Mor. 39 Kr.). This pattern of Galenic moral reform coincides with Michel Foucault’s view of how the care of the Self grounded in psychosomatic well-being can become a means of helping the Other, and how a preoccupation with the particularity of the Other facilitates moral treatment and progression. In Avoiding Distress, the care of the Self is elucidated through Galen’s autobiographical introspection, and the particularity of the Other explained by the addressee’s long-standing acquaintance and emotional relationship with the author. As Foucault further stresses, works of the Principate that are primarily concerned with the interplay between the care of the Self and helping the Other build on ‘pre-existing relations’ between author and reader and cause an ‘intensification of existing social relations’,³⁰ ideas that are completely in line with Galen’s understanding of the moralising power of friendship in Avoiding Distress.

On another level, Galen’s self-presentation as an ethical authority in the tract resembles his self-projection in his medical case histories. Those embedded clinical encounters do far more than just explore the stages of the diagnosis, treatment and prognosis of the diseases of particular patients (on which more in Chapters 7 and 8). They attest to Galen’s superiority as a physician, reanimating through auto-recollection the reactions of his peers to his medical performances.³¹ The most common response was amazement.³² In one of Galen’s most fascinating texts, Prognosis, the Peripatetic philosopher Eudemus admires Galen and advertises his medical competence to high-ranking figures in Rome,³³ while elsewhere Galen attracts admiration of the Imperial circle by curing the young emperor.³⁴ Similarly, Galen’s medical efficacy is backed up by the addressee’s own confirmation of the former’s claims (the frequent aside ‘as you very well know’),³⁵ as someone who has been constantly present during the performances. Finally, although the author is portrayed as an exceptional physician, he is never isolated from his social circle, which includes a range of teachers, patients and physicians. The communal experiences he shares with his addressee, Epigenes, in particular and the direct interaction between the two expressed in the use of the sociative ‘we’, make Galen’s medical narration a social rather than a private act.³⁶ A similar collaborative approach informs Avoiding Distress, suggesting that in transmitting his personal ethical assertions, Galen is not alone, but at the very heart of his surroundings, a philosopher embedded in society. I will return to this point below.

When Galen was composing his Avoiding Distress, essays on psychic tranquillity were already in circulation, for instance, by Democritus and Panaetius (now lost), and by Seneca and Plutarch. More specifically, Plutarch’s preface to his own Tranquillity of the Soul offers a good comparandum regarding the construction of authority and the relation between author and addressee in such moral contexts. This is an epistolary essay too, which Plutarch addresses to his Roman friend Paccius in response to the latter’s request for a treatise on emotional resilience. In this case, Plutarch bases his ethical potential not on his moral experiences,³⁷ like Galen, but on the philosophical material he is able to elaborate in written form: a work of practical ethics after direct consultation of his personal note-books (hypomnēmata) on the one hand³⁸ and an exegetical commentary elucidating some thorny passages from Plato’s Timaeus on the other (De Tranq. Anim. 464 E-F). In the rest of the essay, Plutarch is lecturing, seeking to mould his addressee’s behaviour. For instance, he praises Paccius for not succumbing to the evils of fame, and prizing social standing (De Tranq. Anim. 465A) and elsewhere castigates him on suspicion of self-interest and overindulgence (De Tranq. Anim. 468E). As a character in the narrative Paccius gradually fades away and becomes a constructed substitute for a larger audience enjoying Plutarch’s moral advice. That is not quite the case with Galen’s anonymous friend, who is cast as being closely attached to the author throughout the narrative in such a way that the plot makes sense as long as the anonymous friend remains an essential part of what we read. That Paccius’s role in not as vital as that of Galen’s friend might also be seen in the fact that Plutarch’s essay is not context-specific, in the fashion of Avoiding Distress, but concerned with a large number of situations that could generate distress.

In Seneca’s On the Tranquillity of the Soul the author is also depicted as a qualified philosophical teacher, who provides his addressee, Annaeus Serenus, with a sequence of precepts to be adopted.³⁹ Epictetus is a similar case in point, since his Discourses and Manual (as preserved by his pupil Arrian) communicate to his fragile young students his ethical lessons through imperatives and hortatory subjunctives.⁴⁰ This aligns Epictetus’s didactic style with Maximus of Tyre’s exhortatory perspective that ‘the summit of philosophy and the road that leads to it demand a teacher who can rouse young men’s souls and guide their ambitions’ (Oration 1.8). Of course, the authoritative pedagogy practised by these philosophers does not resemble Epicurus’s coercive therapy.⁴¹ But it is nevertheless in stark contrast to the intrinsically co-operative relationship between author and addressee in Avoiding Distress that underlies the therapy of distress, in line with the message of the two poetic quotes opening this Chapter.

The revived reality of the loss

We have seen in the previous section that ‘Galen’ refers to Philides the grammarian, who died of distress at the loss of his books. Apart from functioning as an example to be avoided, this incident helps to reperform the public response to the fire. ‘Galen’ reports that most people stored their possessions in the Temple of Peace, having complete confidence (expressed with the recurrent cognates of θαρρεῖν, Ind. 1, 56.28 PX, 1, 56.30 PX; 1, 58.35 PX) that the repositories were fireproof. The tragic overturning of their expectations gives rise to their disappointment, to which Galen did not subscribe.

In a new section he stresses that, apart from the general disaster, Galen alone had suffered a personal misfortune (ἴδιον, Ind. 1, 58.36 PX) that was all the more discomfiting: as he was about to visit his estate in Campania, he had decided to store all his valuables in the repositories to keep them safe, but instead he found that everything had been destroyed. Even so he was not upset even for a moment, and this purportedly motivated the addressee to request a first-hand account of the event from Galen, although he had already learnt about it through witnesses, as noted above. By virtue of his emotional aloofness from common reactions and his addressee’s acknowledgment of his exceptionality, Galen gives his reader a sense of security; and, as the narrative progresses, he reconstructs a blow-by-blow description of the loss (more extensive and systematic than the one we have seen in the preface), meant to incite a feeling of retrospective distress in the reader. The author reforms his addressee’s behaviour by assigning him specific thoughts and corresponding emotional reactions. These manipulative strategies take the form of asides in the second-person singular and are akin to what we nowadays call the power of ‘suggestion’, a term coined by nineteenth-century psychologists such as William James.⁴²

The asides start to appear at the juncture where we pass from the past tense, in which the correspondent’s epistle was reported, to the present tense, in which ‘Galen’ now focuses on the after-effects of the loss. He plainly says that even today he can feel the loss of all those things that were essential to his practice every time he needed a book, instrument or drug (μέχρι νῦν αἰσθάνομαι καθ᾽ ἑκάστην ημέραν, Ind. 2, 58.7-8 PX); and directly ‘suggests’ a first thought to his friend: ‘But in fact the most dreadful matter (δεινότατον) associated with the loss of the books has escaped you (λέληθέ σε), and there is no hope (μηδὲ ἐλπίδα) of recovery remaining, since all libraries on the Palatine were burned to the ground on that day’ (Ind. 2, 58.9-11 PX). In the reproduction of the friend’s letter, ‘Galen’ allowed some hope for the recovery of his medical instruments, although he was clear that this would take a significant amount of time and effort (Ind. 1, 56.18-19 PX), whereas in this case the elimination of any hope transposes a sense of retrospective despair to the addressee:

It is accordingly impossible to find not only works that are rare or unavailable from another source, but also the common ones that were eagerly sought out for the precision of their text, those of Callinus, Atticus, Peducaeus and of course Aristarchus, by whom are the two Homers, and also the Plato of Panaetius and many other such writings … For in fact autograph copies of many ancient grammarians, orators, physicians and philosophers were stored there.⁴³

Ind. 2, 58.11-60.18 PX

The valuable legacy to posterity has been burned to ashes, but Galen’s narration becomes even more powerful when he claims that, in addition to the numerous books, he lost that day his own recent editions, which were so carefully arranged that ‘not even a single or double marginal mark or a coronis suitably placed between books’ (Ind. 3, 60.3-6 PX) had been destroyed. In that category belonged the works of iconic figures of Graeco-Roman philosophy and medicine (Ind. 3, 60.8-62.10 PX). The emphasis on the diligent and time-consuming textual preparation of important works augments the emotional impact of the loss.

The same pattern recurs later in the text; a reference to a group of perished intellectual treasures is accompanied by two manipulative asides, which now stir up not the idea but the emotion of distress itself: ‘Above all, however, you will be distressed by the fact that, (Λυπήσει δέ σε καὶ ταῦτα μάλιστα) beyond the books recorded in the so-called Catalogues, I found some in the Palatine libraries …’ (Ind. 3, 62.10-12 PX), by which Galen means that he had come across rare works of limited circulation that had also now disappeared for ever. In similar fashion: ‘Perhaps you were also distressed (Ἴσως δὲ ἐλύπει) by the unfortunate outcome of my treatise on Attic nouns and collections of everyday language’, a work comprising two parts, one drawn from old comedy and the other from prose-writers (Ind. 5, 64.1-3 PX).

In order to increase the reader’s anxiety with variations on a theme, Galen now adduces the role of fate (tychē), a traditional topic in ethical works of the post-Hellenistic period, which is also addressed in his Exhortation to the Study of Medicine (Protr. 2-4, 85-88 B. = I.3-6 K.), as we will see in the next Chapter. Fate is a media vox, sometimes known for its benevolence and at others for the unexpected blows that plague human life, hence showing the need for philosophical instruction as a protective medium. Galen, so he tells us, had made copies of all his works intended for distribution, but had by chance (κατὰ τύχην, Ind. 5, 64.3 PX; cf. κατὰ τὴν τύχην, Ind. 7, 68.3 PX) only transposed to Campania his work on prose-writers, which was saved. His remark that the same fate that had favoured him also ambushed him (ἐνήδρευσεν οὖν ἡμᾶς ἡ Τύχη, Ind. 5, 66.14-15 PX) brings us one step closer to the emotional climax and leads Galen to linger on the loss of his study of the vocabulary of old comedy, explaining the significance of which takes him no less than two whole paragraphs (Ind. 6, 66.1- 7, 68.5 PX).

In contrast to the feeling of distress with which the addressee is now afflicted, ‘Galen’, describing his own emotional state, reiterates that none of these losses had grieved him (Τούτων οὖν οὐδὲν ἠνίασέ με, Ind. 7, 68.5 PX; ἀλλ᾽ οὐδὲ ταῦτα ἐλύπησεν, Ind. 7, 68.10 PX), although they were substantial and hard to replace, not even the destruction of his hypomnēmata and a large number of medical and philosophical works. The affective gap between the two parties produces a state of complete amazement in both the primary and the secondary audience: ‘What on earth, you will say; is even greater than all the items mentioned that could cause distress? Well, I shall tell you what this is.’ (Ind. 8, 68.1-2 PX).⁴⁴ Galen was convinced that he possessed the most remarkable drug recipes in the Roman world, brought to him by a twofold fate (Διττή … τύχη, Ind. 8, 68.5 PX). His rhetorical question, however, and more especially his assertive ‘I will tell you’ at the end of the quote, are misleading, as we do not, in fact, get any answer as to whether the loss of his drug collections upset him or not. Instead, Galen redirects the questions ascribed to his addressee, who no longer cares which of the many disasters would have aroused the most distress in Galen (obviously none of them!), but only why he was not grieved like other men at the loss of such a great variety of possessions (Ind. 9, 72.5-8 PX). Therefore, prima facie, Galen’s moral heroism in the rhetorical question quoted above borders on self-praise, but on closer inspection it actually emphasises his emotional resilience, so that it acts as a therapeutic strategy in the interests of his reader’s moral progress. The text is by itself a suggestive entity, conveying to the reader the idea that the authorial self is a unique role model among his contemporaries, whereas the reader will himself become one of those ‘Others’ troubled by distress unless he follows Galen’s lead. Galen, as a soul doctor, has helped the reader develop an introspective consciousness of his own psychic frailty and shown him, as a critical entity, his pressing need for therapy.

Traditional instruction and Galen’s ethics

In a new section of the essay, Galen exploits the repertory of moral instruction familiar from the works of other moralists. One notices, for instance, the use of moral anecdotes and quotations from authorities, to which Galen adds individual twists. His place in the legacy of moralia is confirmed by the reminder he puts in the mouth of his addressee that the latter has heard him expounding similar ethical pronouncements many times in the past (Ind. 9, 72.9-11 PX).⁴⁵

The moralising part starts with Aristippus of Cyrene, an important follower of Socrates, who became proverbially known in works of ethics for his self-gratification. Aristippus also appears in Plutarch’s Tranquillity of the Soul 469C-D, where he is an example of a wise man rising above the unpleasant conditions of life.⁴⁶ In contrast to Plutarch, Galen recounts two anecdotes about Aristippus that point to the importance of self-sufficiency and hence to the idea that the loss of wealth should not be a matter for sorrow. Furthermore, Galen intertwines the moral of the anecdote about Aristippus with his own ethical voice, when he declares that he shares Aristippus’s point of view:

[H]e (i.e. Aristippus) nicely demonstrates what you heard me say many times, namely that one should not focus on anything that has been lost, but rather consider how those who have inherited three fields from their father will not bear to look at others with thirty.⁴⁷

Ind. 10, 74.11-15 PX

Galen offers mind-control techniques that secure happiness: i.e. that we should refrain from having too many desires which can hardly ever be satisfied, and should be content with what is sufficient to life, both stances akin to what we call ‘attitude of gratitude’ in modern psychology⁴⁸ and which go as far back as Epicurus.⁴⁹ Galen’s advice becomes more appealing when he provides moral evaluation of what is considered ethically admirable (Ind. 10, 74.25 PX).⁵⁰ To his mind, the magnanimous person is not the one who is not distressed at being left with three fields, but the person who is destitute and still bears his poverty without distress, such as Crates, Diogenes and especially Zeno, who also represents a model of self-sufficiency in Plutarch’s account (De Tranq. Anim. 467C-D).⁵¹

Galen has so far employed commonplaces to present his moralising in a protreptic fashion, but again a personal note creeps into the discussion. He explains in two instances⁵² that it was not such a great thing for him to despise the loss of his possessions, because he was always left with much more than he needed. By the same token, it was not important that he had not prized his position in the Imperial court (Ind. 11, 76.11-14 PX), or that he had lost all his drugs, books and recipes, and the writings on them he had prepared for publication along with many other treatises (Ind. 11, 76.14-19 PX). The recapitulation of his losses in reverse order here is not simply a textual reminder, but an ethical strategy with more complex connotations. We have seen in a previous section that, on his return to Rome, Galen came to realise every day the importance of the loss and found himself in need of particular books, instruments or drugs. All these things he now considers superfluous, judging by his particular use of the participle καταφρονήσαντι (‘having despised’) echoing the Stoic belief in ‘indifferents’:⁵³ the only thing that determines happiness is virtue, and everything else, including wealth, health, fame and social prominence, are moral indifferents, factors that cannot affect individual happiness.⁵⁴

Galen’s philosophical spirit is practical rather than theoretical, especially in instances such as these in which he speaks as a social critic, aiming at correcting the deviant morals of those around him. Second-century Graeco-Roman society is often seen – and was seen at the time – as a profoundly competitive one, in which personal elevation became an end in itself, very often ignoring the weight of morality. In the introduction to his Prognosis, the two proems to the Therapeutic Method and his Recognising the Best Physician, all of which to some extent take the form of ethical diatribes,⁵⁵ as we shall see in other parts of this book, Galen comments on the degeneracy of his times and criticises in particular the corruption that afflicted physicians in Rome.⁵⁶ He frequently expresses his desire to abandon the capital and move back to his native town, which he paints in a more positive light. The distinction he makes between Rome and the Greek East is symptomatic of Galen’s pride in being a Hellene, a topical issue in Second Sophistic discourse, especially when it came to the responses of Greek intellectuals to Roman rule.⁵⁷ We will see below that Galen criticises Commodus’s rule, whereas we have already observed that Galen’s correspondent in this case is a fellow Pergamene and not a Roman dignitary, like Plutarch’s Paccius. That said, the moral dimension of geographical space in Galen is also critical, as I will argue in Chapter 8.

Now, it is important to note that in Galen’s public debate in Avoiding Distress, designed to advise contemporary readers, he borrows convenient terms or adopts individual tenets and strategies from Stoicism (despite his general hostility to Stoic psychology),⁵⁸ because this was considered a very fully worked out kind of philosophy, a way of life, and hence one that suited his pragmatic spirit. Galen, for instance, suggests a method of preparing for future evils (praemeditatio futurorum malorum), one of the fundamentals of Stoic psychotherapy and shared with the Cyrenaics, according to which the anticipation of traumatic experiences might lead to an increased ability to endure them when they happened.⁵⁹ Although this meditative practice seems to be a point of contention among philosophers – Epicurus, for example, claimed that distress is either bearable or short and that we should thus not aggravate it by focusing on its imagined visualisation⁶⁰ – Galen is openly in favour of it (Ind. 12, 78.8-13 PX).⁶¹ Again the moralising is not simply thrown at the addressee as an injunction to adopt without further consideration, but it becomes a vital element in their common experiences. The addressee is actively involved in the narrative when ‘Galen’ reminds him of the crimes committed by Commodus and how his political fears had schooled Galen’s imagination (ἐγύμνασά μου τὰς φαντασίας, Ind. 12, 80.20 PX) and prepared him for the total loss of all his possessions. Τhe notion of φαντασία again goes back to the Stoics, generally referring to the impressions that are created in the mind when the senses are stimulated by external phenomena. Thus ‘Galen’ advises his friend to practise using his own imagination too (ἀσκεῖν παρακελεύομαι τὰς φαντασίας σου τῆς ψυχῆς, Ind. 13, 80.2 PX) by anticipating being confronted with the possibility of exile, a common threat during the reign of Commodus. Here Galen is certainly addressing a larger group of people too, who must have been aware of the capricious politics of the Roman emperor, and giving them practical ethical means to withstand the possible dangers deriving from his oppression.

The practical tone of Galen’s ethics is not the product of Stoic influences or social commentary alone, but also of his personal experience. Around the end of the essay, ‘Galen’ raises a central issue in ancient ethics when he claims that his training of the imagination was based on a combination of proper natural propensities and excellent education (Ind. 13, 80.3-5 PX). This gives him the opportunity to discuss the contribution of his father to his ethical upbringing, a topic of which Galen is very fond.⁶²

Galen’s moral enterprise was indebted to the Platonic and Aristotelian educational model, which maintained that human character was shaped by the right mixture of nature (physis) and training (askēsis).⁶³ Although in the passage we have just seen he presents both aspects as informing his own education (also Ind. 14, 82.1-2 PX), in referring to his father he makes clear that he was a man naturally endowed with qualities of character without having been exposed to the influence of philosophers (Ind. 13, 80.8-82.3 PX). Galen’s position on physis is a complex one, because he uses it with semantic flexibility across a variety of texts. For instance, in his Character Traits he talks about features of character that appear in infants as soon as they are born, and, correspondingly, states that anger and revenge are inherited, not learned, traits in man.⁶⁴ Physis seems somewhat less important in the Exhortation to the Study of Medicine (see Chapter 5) and more especially in Affections and Errors of the Soul, where nature together with early education and the application of reason represent the educational triad that made Galen immune to distress,⁶⁵ whereas in Doctrines of Hippocrates and Plato training trumps nature.⁶⁶ In Avoiding Distress, the triad excludes physis altogether and replaces it with rational arguments instead (Ind. 1, 54.1-2 PX). The reshaping of the same notion is to be explained in the light of each disquisition and its purpose(s) in each case.

To be more specific, Galen devotes a separate section of the Affections and Errors of the Soul to narrating the case of a young man in his close circle, who was surprised that Galen was not vulnerable to great disasters, whilst he himself was distraught even at trivial ones. When he sought an explanation for this, Galen told him that ‘nature has great power in childhood, so too does emulation of those amongst whom one lives, then at a later stage the important factors are doctrines and training’ (Aff. Pegg. Dig. 7, 25.21-24 DB = V.37.12-14 K.).⁶⁷ Textual evidence suggests that this essay is indeed addressed to a young man whose philosophical education is still at an elementary level, as will be argued in more detail in Chapter 6. For instance, he needs a moral supervisor to criticise his conduct (Aff. Pegg. Dig. 10, 36.16-17 DB = V.55.4-6 K.)⁶⁸ and there is an emphasis on the moral failings to which young people were especially attracted (Aff. Pegg. Dig. 26, 12-14 DB = 38.11-15 K.),⁶⁹ both ideas absent from Avoiding Distress. Therefore, the omission of physis as a determinant of psychic harmony at the beginning of Avoiding Distress is well adapted to the advanced philosophical stage of his addressee, who was expected to be indifferent to something that would affect someone in the initial stages of their training. On the other hand, the focus on the untutored nature of Galen’s father would have no place in an essay meant to teach young men the prime importance of correct training. The insertion of physis in the context of Avoiding Distress reflects Galen’s philosophical perceptiveness, because it is characteristic of Platonic-Aristotelian educational thinking on ethical development from which he drew inspiration, but not the Stoic approach, according to which early influences and instruction alone shape one’s moral character.⁷⁰ It is obvious that Galen’s eclectic subscription to different philosophical schools serves the aims of his practical ethics. That puts him in the same camp as Plutarch, who also opted for philosophical eclecticism⁷¹ in the context of his moral project, rather than devoting himself to strict adherence to one philosophical ideology, as Epictetus, Seneca or Musonius Rufus had done.

A further caveat should be given about the relationship between Galen and his father. In Galen’s case his father’s role in the formation of his character is not exploited in the text as a philosophical topos, as in the writings of many other ancient thinkers.⁷² Rather, it is an issue informed again by the practical experience he had gained from his own social reality, as can be seen, for example, from his allusion to the great contrast between the evil son Commodus and his philosopher father Marcus Aurelius, a relationship he had witnessed at first hand.⁷³

Galen’s way of treating the issue of the therapy of distress in the two accounts casts fresh light on his credentials as a moral writer, so I want to spend a while comparing them. ‘Galen’ describes how his father’s indifference to worldly pleasures (Ind. 14, 82.3-18 PX) set an example that led him to scorn fame, wealth and social standing (Ind. 15, 82.1-3 PX). In the Affections and Errors of the Soul Galen’s father is again depicted as a model for him by means of a polarised opposition between him and Galen’s wicked mother.⁷⁴ It is interesting, however, that in the Affections and Errors of the Soul Galen’s father is shown teaching him, among other things, the avoidance of distress, though Galen refrains from mentioning this in the corresponding part of the Avoiding Distress, where it would have fitted in well:

I had always recalled the counsel that my father gave me: that one should not be distressed by any material loss provided that what remains is adequate for the care of one’s body. This he laid down as the primary aim of possessions: to keep one from hunger, cold or thirst. If one happens to have more than is necessary for these purposes, one should, he believed, use it for good works. I have, indeed, up to now had access to sufficient resources to bestow in this way, too.⁷⁵

Aff. Pecc. Dig. 8, 30.10-16 DB = V.44.10-45.1 K.

The results of the training received from his father during his formative years as described in the Affections and Errors of the Soul have been internalised by Galen and he now passes it on as a mature philosophical authority in his Avoiding Distress. The link between the two essays testifies to Galen’s consistent train of moral thought; and the variations he makes, according to the requirements of each text, indicate the creativity with which he remodels the impact of emotions. In his proem to the second part of the Therapeutic Method, a technical work addressed to an experienced doctor, one Eugenianus, Galen admits that he had been distressed for a long time, so that he had been unable to touch a book.⁷⁶ Although this remark is at odds with his suggested calmness in his ethical works, it is noteworthy that Galen makes no claims to being an exemplum of moral reflection in the Therapeutic Method. His distress in the prefatory passage to the second part of this work could be a rhetorical explanation for the twenty-year gap between the composition of the first section of the work (Books 1–6) and the second (Books 7–14).

The reference to Galen’s repeated recollection (μεμνημένον) of his father’s counsel at the start of the passage above also merits attention for its salience in the process of moral pedagogy. Just as in the Affections and Errors of the Soul, in Avoiding Distress too Galen emphasises how remembering his father’s image makes him feel his soul is the better for it (ἀναμιμνῃσκόμενος ἑκάστοτε, βελτίων ἐμαυτοῦ τὴν ψυχὴν αἰσθάνομαι γινόμενος, Ind. 13, 80.6-7 PX). The notion of recollection (ἀνάμνησις) is critical in Imperial-period moral philosophical works.⁷⁷ In a passage in his Table Talk Plutarch appropriated the Platonic notion of recollection when he states that remembering (ἀναμνήσεις) very often has the same effect as learning does.⁷⁸ Galen is writing in the same spirit when he says elsewhere that recollecting people with moral vices makes one a complete entity,⁷⁹ generating moral progress. Moral anamnesis in Galen is therefore much more important to his apparatus of ethical modification than Ricardo Julião seems to have allowed.⁸⁰ On another level however, one wonders whether Galen’s focus on the concept of remembering may also have medical origins or links, rather than purely philosophical ones, given that in his Matters of Health remembering is part and parcel of successful bodily therapy as it is elsewhere, requiring the physician to recall every single day the diagnosis he had given on the previous day.⁸¹ The recurrence of cognates of anamnesis in this context helps Galen make the point that the act of remembering the patient’s somatic condition will expose the fault in his body and determine the appropriate treatment.⁸²

Philosophical refutation through personal experience

In the last part of the treatise, Galen gets involved in philosophical debates regarding distress and more specifically the definition of apatheia. This passage helps us see how he understands this philosophical concept and makes us aware of the way he deploys it with syncretic flexibility. Although there are instances where Galen is a proponent of the Aristotelian belief in the moderation of emotions, known as metriopatheia,⁸³ there are other instances, for instance in his Affections and Errors of the Soul, where he seems to advocate complete freedom from affection (apatheia).⁸⁴ In Avoiding Distress he rejects Stoic apatheia, as he is keen to make clear that he has never seen anyone so wise as to be completely free from affections (Ind. 16, 84.5-6 PX). Here the allusion is to the Stoic sage, a paradigm of emotional imperviousness, with whom Galen does not want to be identified. Thus, the apatheia he has claimed to exercise throughout the essay has its limits:

For I disregard the loss of belongings as long as I am not deprived of everything and banished to a desert island; and [I disregard] bodily pain as long as I am not required to promise that I disregard the bull of Phalaris.⁸⁵

Ind. 16, 84.7-86.9 PX

The bull of Phalaris, a symbol of extreme physical torture in antiquity, is an allusion to the commonly held thesis among Epicureans and Stoics whereby the sage, in light of his ataraxia and claims to detachment, taught that life was pleasant even amidst sufferings.⁸⁶ Scholars have been perplexed by Galen’s unclear attitude towards apatheia and metriopatheia,⁸⁷ but at least in Avoiding Distress Galen seems to support a modified version of apatheia, freedom not from all emotions but from violent and disruptive ones.

The regulated apatheia he professes on a philosophical level also squares with Galen’s self-portrait as an ethical archetype. His admission that the destruction of his homeland or a friend’s punishment by a tyrant could cause him distress (λυπήσει δέ με, Ind. 16, 86.9 PX) shows that he now wants to be seen as a model that could be emulated by his readers, since his previous superhuman self-composure would have been beyond the capacity of normal people. So he goes on to pray to Zeus that no distressing event will ever happen to him, radically modifying the corresponding prayer of the Stoic Musonius Rufus, who used to ask Zeus to test him with any affliction. Likewise, he accepts his human weaknesses and acknowledges the unexpected frustration that he might feel as a result of changes to his physical and psychic state. Galen’s counsel against distress is here invested with his practical experience, because he never claims to be able to do what he had not shown himself capable of in practice (Ind. 16, 88.34-36 PX). His experience in this instance is a vehicle of persuasion.

Galen’s ethical optimism is also seen in the final address to his correspondent, which places the latter alongside Galen in terms of nature and education (Ind. 16, 88.41 PX) – a sign of merit. By the end of the text two categories of people have been established, the first represented by Galen’s addressee who prefers simple food and dressing and is sexually restrained, the second group including all those people who are slaves to sexual desires and can never satisfy their longing for money (Ind. 17, 90.2-8 PX). Galen’s ethics feeds into the realities of present-day life, since it acknowledges the tendency to aspire to social and political prestige that drives the elite. Here he connects patterns of behaviour to different types of people and reinvigorates assimilation and distancing strategies,⁸⁸ similar to those explored in Chapters 1–3. Thus, those people who are only moderately attached to esteem, wealth, reputation and political power are less likely to be afflicted by distress; people whose desires for public reputation are insatiable will lead miserable lives, unaware of the virtue of the soul and suffering grinding distress (Ind. 17, 90.9-15 PX).⁸⁹ In assessing the two groups, Galen attempts to shape his audience’s moral discernment and related decision-making. Critical to that process was also the way Galen showed his readers what would be the more socially acceptable course of action of the two presented to them, thus playing on their sense of social esteem, a pivotal quality of Graeco-Roman aristocracy. So by proposing a particular lifestyle, which Galen hopes the reader will follow, Avoiding Distress effectively shares features of the genre of advice literature (as distinct from that of therapeutic literature, according to the ancient classification).

The two kinds of moral attitude that Galen describes above do not stem from theory but from experience, which Galen now calls ‘a teacher of the unexpected’ (᾽Aλλ᾽ἡ πεῖρα καὶ τῶν ἀπροσδοκήτων διδάσκαλος γίνεται, Ind. 18, 90.1 PX). Elizabeth Asmis has hypothesised that Galen’s reflections in his Avoiding Distress encapsulate a ‘personal’ kind of philosophy, ‘which is integrated with one’s life’.⁹⁰ This has been construed in the light of Galen’s attachment to truth within the essay, but I think that his life experiences as well as his professional experience help bolster the notion of integration that Asmis sees in Galen’s personal philosophy. The quote above shows that, in Galenic ethics, experience functions strategically as a means of premeditation and a guarantor of success, as it is indeed in technical contexts, for instance in his The Capacities of Foodstuffs⁹¹ or in his pharmacological essays The Composition of Drugs According to Kind and The Composition of Drugs According to Places.⁹² At the same time, it is also a philosophical motivation for the composition of moral works. At the end of Avoiding Distress Galen’s daily experience with ordinary men stimulates him to reflect on the topic of love of wealth (φιλοπλουτία) – a traditional part of the remit of practical ethics – and write a separate treatise on that, which he also sends to his penfriend (Ind. 18, 92.5-7 PX).

Conclusion

In this Chapter, I have explored Galen’s characteristics as an ethical philosopher in the light of his newly discovered work Avoiding Distress. I have shown that his personal reflections on the issue of anxiety related to a particular event from his life help him build a strong ethical voice. And that by reliving his experiences as the victim of the calamity, he offers a precedent of actualised behaviour that can be actualised again, convincing the reader that he has firm knowledge of how to dispel anxiety in similar cases. That Galen’s correspondent is not a mere literary construction but an active associate in the process of reading points to the intimate character of Galen’s ethics and, on another level, helps make his psychological therapy more effective. The exposition of Galen’s losses is revealed gradually and is permeated with his manipulative asides, which suggest to his addressee and secondary audience considerations and emotions that retrospectively revive the feeling of distress until they ultimately free themselves from it. On many occasions, Galen’s applied ethics dovetail with his self-depiction as a practising physician, especially as regards the construction of his authority, the credibility of his account, the importance of personal experience, the issue of the amazement aroused by his performances, and the salience of anamnesis in the process of moral therapy and progress. All these individual features are hardly likely to have occurred in other, now lost, essays peri alypias, although this assumption must remain a speculative one.

In his Avoiding Distress, Galen resorts to moralising devices of considerable sophistication by combining philosophical remedies from different schools of thought. The rich Stoic background mixed with material from the Platonic and Aristotelian tradition situate Galen firmly within the genre of the therapy of emotions. But at the same time this mix shows that what matters mostly for him is the moralising impact of the philosophical material he is using, even if this means drawing material from schools he was not generally in favour of. His statement towards the end of Avoiding Distress that he neither wrote this essay with zealous enthusiasm nor considering it an important task, but simply as a sort of pastime (Ind. 15, 84.8-9 PX) is more likely a trope of self-effacement. The dynamics of Galen’s ethics not only in Avoiding Distress but also as it evolved in Affections and Errors of the Soul and elsewhere, expressed in the subtle retexturing of his ethical instruction according to the philosophical level of his addressee and the needs of the argumentation in each case, demonstrates that this statement is not to be trusted.

But the best judge of success is always the audience and, at least as far as Avoiding Distress is concerned, its programme of psychological therapy has proved to have benefited not only contemporary readers. The Vlatadon manuscript preserves a number of scholiastic lines of Byzantine verse acknowledging Galen’s ethical precepts:

Thanks be to you, Galen, for your advice, in which you teach all mortals to bear the uncertainties of life without distress, and not be disturbed at all by the losses; … In repeated misfortune, you are a clear beacon in your life.⁹³

This testimony to the Byzantine reception of the text encapsulates the main point I have made here, that the author’s life experiences profoundly inform the suggested cure for distress. Most significantly, it acknowledges Galen’s contribution as a moral philosopher whose intellectual ambitions embrace the therapy of the emotions across a broad social spectrum.

Chapter 5 Exhortation to the Study of Medicine

In his history of ancient Rome, Cassius Dio records the story of Gellius Maximus, a legionary commander in Syria, who in 219 AD raised a revolt against the Roman emperor in order to assume supreme power. Cassius considers this incident a most fitting revelation of the degeneracy of the Imperial world, in that the son of a physician had aspired to become emperor (Roman History 80.7.1-2). Whatever the historical accuracy as to the social status of the person involved,¹ the story reflects long-standing prejudices against medicine, which had not always been a well-respected profession.² One of Galen’s most structured attempts to respond to such biases in a single work is perhaps his Exhortation to the Study of Medicine (henceforth in its abbreviated form Exhortation), which aimed to elevate the status of the art he was so passionately serving.

The Exhortation, classified among Galen’s works related to the empiricist medical school,³ is an unusual treatise both in the topics it tackles and in its style and form of argumentation more generally. In the first part (chapters 1–14), the author discusses the importance of engaging with the liberal arts, preparing the ground for a more specialised exaltation of the greatest of them, medicine. That was explored in the second part, which does not survive.

The dual subject of the work might partly explain its controversial title, which continues to perplex scholars to this day. Should it be called Exhortation to the Study of Medicine, as Galen himself appears to have called it in My Own Books?⁴ It is given this same title by St Jerome in the fourth century⁵ and by Ḥunayn ibn ʾIsḥāq (d. 873) in his Arabic translation of the title.⁶ Or should it be called Exhortation to the Study of the Arts in accordance with the quite reliable Aldine version (dated to 1525), our earliest surviving testimony of the work in the absence of any Greek manuscript?⁷ Whatever the answer to that might be, the existence of two alternative titles found in the various stages of the transmission of the text shows with some degree of certainty that, when the treatise was rediscovered in later times, its two sections must have been received as distinct thematic units,⁸ presumably serving the purposes of different readerships. There is no evidence, however, to suggest that the work circulated in two different parts in Galen’s own time. Therefore it would be fair to say that it was originally published as a single entity and intended for a specific audience, as will be discussed below.⁹ Furthermore, although we are not in a position to reconstruct the lost part on medicine, scholars have been right to suggest that it must have contained traditional material about the importance of the medical art, which Galen would have employed in other instances within his corpus, for instance in The Best Doctor is Also a Philosopher.¹⁰ Conversely, Galen’s encouragement of participation in the arts, which reflects his interest in philosophical education per se, points to a less familiar aspect of his thinking and one that can help us penetrate below the surface appearance of an allegedly technical treatise.¹¹

In this Chapter, I wish to focus on the moralising techniques that permeate Galen’s Exhortation and explore how these inform the construction of his moral authority. I want to look, in addition, at the ways in which he tailors his ethical advice to respond to the needs of his intended audience, comprising, I would suggest, adolescents who are about to start their intermediate education and are being urged to engage with professional studies, beginning with philosophy and progressing on to medicine. I aim to throw some interpretative light on this relatively neglected work by also discussing its rhetorical force vis-à-vis its literary peers (both earlier and later)¹² and especially by arguing that Galen is influenced by Plutarch, as a key moralist of the early Roman Imperial period, in his writing.

The surviving essay can be divided into two sections; chapters 1–8 juxtapose the permanent benefits of acquiring skills in the arts with unpredictable changes of fate, while chapters 9–14 describe at some length the risks associated with intense physical exercise.

Arts vs Fate

We have seen in the previous Chapter that Galen employs the philosophical subgenre of therapy to instruct his anonymous friend as well as a wider audience on how to manage the destructive emotion of distress. In the Exhortation Galen engages with another ethical subgenre, that of the protreptic, which conventionally aims to encourage (προτρέπειν) the study of philosophy and the attainment of virtue.¹³ That is the approach employed, for instance, in Plato’s Phaedo and Euthydemus,¹⁴ in Aristotle’s fragmentary Protreptic,¹⁵ Isocrates’s Antidosis¹⁶ or the much later Protreptic by Iamblichus (ca. 245–ca. 325 AD),¹⁷ although the origins of the genre may go back as far as the writings of the fifth-century sophists.¹⁸ Also associated with the exhortative performances of professional orators in law courts (e.g. those of Gorgias or Lysias), the protreptic continued to be used to persuade an audience not so much through rational arguments as through emotional appeals. As such it became a philosophical genre with rhetorical force, or more broadly a combination of rhetoric and popular philosophy.¹⁹ In many instances, I will explicitly show the function of what I call Galen’s ‘moralising rhetoric’, which makes use of epideictic elements to bring about his readers’ self-reform.²⁰

The Exhortation starts with Galen expressing some scepticism as to whether the so-called irrational animals are indeed entirely devoid of reason.²¹ Such agnostic statements often have a rhetorical purpose rather than being intended as a philosophical stimulus for further reflection, because they are often immediately countered by a remark reflecting Galen’s certain knowledge so as to win the reader over.²² Thus, in this instance, he goes on to assert that, although some animals possess at least some degree of reason, they certainly do not have the capacity to learn whichever art they choose in the way man does (Protr. 1, 84.8-13 B. = I.2-3 K.).²³

The sharp distinction between rational humans and irrational animals was posited in orthodox Stoicism by Chrysippus,²⁴ who surmised that animals could not be endowed with any reason. But Galen seems to take a more flexible stance here by accepting the existence of at least some sort of animal intelligence. This aligns him with the Stoic Posidonius of Apamea (ca. 135–ca. 51 BC), who, as Galen himself tells us in the Doctrines of Hippocrates and Plato, attributed emotions to animals such as pleasure (ἡδονή) and anger (θυμός).²⁵ Moreover, Galen’s eagerness to acknowledge the limited existence of animal rationality rather than dismiss it altogether shows how close he is to Plutarch’s influential thesis that all animals, to a greater or lesser extent, are endowed with reason. Plutarch was central to the debate over the mental capacities of animals in that he devoted three separate treatises to exploring the issue systematically, viz. On the Cleverness of Animals, Whether Beasts are Rational (also known as Gryllus) and On the Eating of Flesh, as well as independent discussions in other essays in his Moralia, for example in On the Love of Offspring and Table Talk, all of which, as Stephen Newmyer has persuasively contended, attest to his substantial contribution to this philosophical question.²⁶ Above all Galen’s reference to the intellectual abilities of land animals²⁷ (rather than of marine creatures) and, in the same context, the employment of illustrative examples that entail specifically spiders and bees,²⁸ are elements found in Plutarch’s animal-related accounts,²⁹ which make a strong case for Galen’s dependence on him.³⁰ This is part of a broader proposal I will be making throughout, which is primarily supported by the fact that Galen was well aware of the work of Plutarch, quoting from it several times throughout his writings either explicitly or in less direct ways.³¹ In the Exhortation Galen’s emphasis on man’s ability to learn and perform any art, a skill that as a rule all other animals lack, seems an intentional reversal of Plutarch’s On the Cleverness of Animals 966E-F, which refers to spiders’ webs being admired and imitated by man in weaving. Galen focuses more on man’s limitless ability to imitate and learn, which transcends animals’ inborn and very limited set of skills.³² This twist serves as the springboard for the ensuing narrative, in which Galen establishes the uniqueness of man by explaining his potential for practising the arts as the result of deliberative choice (prohairesis)³³ rather than of inherited nature (physis).³⁴

The reference to prohairesis (‘volition’ or ‘reasoned/moral choice’) is important on account of its association with the Platonic and Aristotelian educational model, where it constitutes a decisive aspect of virtue and character.³⁵ In fact, the distinction made between humans and animals in this prefatory context is predicated on the assumption that education (paideia), as a product of exercise and habituation, is an exclusively human asset. That explains why Galen goes on to stress the significance of training for human education³⁶ and to praise the continuous effort that helps man acquire the most outstanding of divine gifts, philosophy.³⁷ Galen therefore provides justification for the necessity of studying the arts, assuring his readers that his literary text is appropriate to their intellectual status.

The elements of irrationality, nature and hard work bring to mind Seneca’s Letter 90, which is also taken to be an exhortation.³⁸ This describes in nostalgic terms the golden age of mankind, in order to stress that the business of philosophy has always been the pursuit of moral virtue by living in harmony with nature, rather than achieving technological progress and material sufficiency. It thus seeks to refute Posidonius’s claim that humans had discovered the arts through philosophical training.³⁹ The emphasis that Galen puts on the notion of training therefore further attests to his affiliation to Posidonius, which in turn makes it highly probable that he might have been influenced by the latter’s lost Protreptic.⁴⁰ On the other hand, by defining the notion of physis as inherited traits rather than a mode of living in harmony with nature (as the orthodox Stoics did), and by associating it with the idea of philosophical practice, Galen situates himself in the Platonic-Aristotelian tradition and shows how experimental he is in his philosophical allegiances. Thus far our author appears as an intellectually diverse thinker, who favours doctrinal interpenetration rather than sectarian devotion, as was also noted in the previous Chapter.

Although some of the notions that Galen expresses up to this point are commonplace in the genre of the protreptic, especially the animal imagery and the role of physis, it is remarkable that he transposes them from theoretical or technical frameworks into a setting of practical ethics, giving them an intimate role in his reader’s moral progress. In Galen’s text the protreptic elements open up direct channels of communication between the experienced advisor (i.e. the author/narrator) and the less experienced recipient, whom Galen expects to learn to become alert and discriminating. For example, he frequently employs the distancing and assimilation strategies we have observed in the previous Chapter, i.e. clever techniques which depict groups of people whom the reader is advised either to despise or emulate so as to acquire virtue. In this way Galen prompts his audience to make the proper moral choices that are characteristic of their philosophical background and which differentiate them from animals, as we shall soon see in more detail. Thus the employment of animal imagery in the context of the Exhortation clearly serves a hortatory purpose,⁴¹ in contrast to its function in three ethical/psychological texts by Galen, Character Traits,⁴² Affections and Errors of the Soul⁴³ and Doctrines of Hippocrates and Plato,⁴⁴ in which animals are treated as representations of the uncontrollable impulses of the irrational faculty of the soul that need to be managed by the rational part and exhorted to obedience and habitual discipline. As such, they bear witness to their Platonic counterparts in the Republic 588c-d or Phaedrus 253c-254a and are inserted into Galen’s argumentation in order to gloss the doctrine of the division and function of the soul, rather than to instruct ethically in an intimate, hands-on and reader-friendly manner. These three texts are surely targeted at readers who were more advanced in terms of philosophical study than the readers of the Exhortation, and who were more in need of help to make sense of philosophical terms and theories on the soul than of helpful advice on how to embark upon a good life.

We have already started encountering cases in which the same elements (in this instance the animal imagery) recur in both technical passages relating to moral psychology and in popular philosophical texts, but which at the same time seem to serve rather different purposes depending on the context and intended meaning of each passage, as well as the intellectual and/or moral level of its recipient. Such retexturing of similar material appears not just throughout Galen’s own ethical and psychological essays, but also in relation to his technical works on how to maintain good health (as we shall see later on), and, interestingly, in relation to other ancient protreptics. For instance, Iamblichus’s Protreptic also suggests that reason renders humans divine and distinguishes them from all other creatures,⁴⁵ but the author does this in order to preach through systematic exposition the value of philosophy in general, and not as a rhetorical device to challenge the reader to immediate moral reflection, as happens in Galen’s Exhortation.

Galen’s text goes on, in chapter 2, to further stress the divide between irrationality and rationality, an issue which is introduced by a set of powerful rhetorical questions expressed in the sociative ‘we’:

Is it not vile, then, to neglect the one part of us which we share with the gods, while busying ourselves⁴⁶ with some other matter? To disregard the acquisition of Art, and entrust ourselves to Fate?⁴⁷

Protr. 2, 85.16-19 B. = I.3.5-8 K.

The above passage, apart from suggesting that humans are capable of union with the divine, thus building on the assimilation strategy, also conveys the two categories of ethical evaluation, praise and blame, in terms of the moral decisions we make as rational agents. The accumulation of terms denoting condemnation and public contempt awakens the reader’s sense of social honour, and Galen’s persuasion technique becomes more forceful once he inserts a word picture of Tychē and of Hermes together with their devotees. The literary ekphrasis of Tychē situates Galen within a long philosophical tradition, which dealt with the mutability of fate in an effort to prove the necessity of emotional resilience achieved through philosophical training. Similar descriptions occur in the Tabula of Cebes,⁴⁸ in Plutarch’s On the Fortune of the Romans (317C-318D) which presents a similar opposition between Fortune and Virtue,⁴⁹ in Dio of Prusa’s Orations 63-65 (three self-contained discussions on fate) and in Favorinus’s treatise On Fortune, with which Galen enters into dialogue, presumably as a result of the ad hominem attack he had made on Favorinus.⁵⁰

Unlike his predecessors, however, Galen dwells on the issue of fate by developing singular twists in his narrative. A striking example of this is the way he incorporates in his Avoiding Distress the destructive fate that incinerated a significant part of his library and medical instruments in the conflagration of 192 AD. We have seen how in that context evoking the vagaries of human affairs was expected to have a direct impact on the psychological state of the reader in that it retrospectively revived the feeling of distress as a way of eventually healing it (Chapter 4). In the Exhortation, however, the dangers of fate do not seem to have any psychotherapeutic function. They are meant rather to guide readers by means of delightful imagery, which in turn might hint at Galen’s concern to make his narrative attractive to people who had yet to become acquainted with the ups and downs of life, without unduly upsetting them.

The assumption of a young readership is reinforced by the similes we find in the description of Tychē in particular, which are intended to help readers visualise its form and associated qualities. The ancients, Galen tells us, depicted Tychē as a woman with a rudder in her hands, a spherical support for her feet and with no eyes.⁵¹ Not only, according to Galen, is her gender a sufficient index of inanity, but trusting her is like committing the same sort of mistake as handing the rudder of a ship in danger of capsizing to a blind helmsman.⁵² The image of the helmsman, which Galen adduces twice more in this text,⁵³ is of Platonic origin with important Presocratic antecedents, and was often employed in ethical tracts of popular philosophy, especially those of Plutarch.⁵⁴

The two groups of followers, those who trust to luck and those who rely on rationality, are illustrated by historical and mythical examples as well as more general allegorical figures each time, making the text even more accessible. So the adherents of Fate are idle and ignorant and comprise a whole band of demagogues, courtesans, betrayers of friends, desecrators of graves and even murderers.⁵⁵ Conversely, Hermes’s followers consist of noble and knowledgeable men of mild conduct, including geometers, mathematicians, philosophers, doctors and scholars alongside architects, grammarians and ultimately such great men as Socrates, Homer, Hippocrates and Plato.⁵⁶ Once he has set up this duality, Galen exploits his protreptic moralism and makes brief encouraging or discouraging remarks to direct the reader more explicitly. In both cases he uses the second-person-singular form of address⁵⁷ and claims that careful examination of the band of Fortune will lead to loathing (μισήσεις ὅλως τὸν χορόν, Protr. 4, 88.13-14 B. = I.6.10 K.), whereas moralising contemplation of Hermes’s chorus will excite both emulation and adoration (Τοῦτον … τὸν χορὸν … οὐ μόνον ζηλώσεις, ἀλλὰ καὶ προσκυνήσεις, Protr. 5, 89.16-18 B. = I.8.1-3 K.).

The reader is subtly prompted to identify with the followers of Hermes by the author’s explanation that this god does not judge people on the basis of political reputation, nobility or wealth, but on whether they lead a good life (τοὺς καλῶς μὲν βιοῦντας, Protr. 5, 89.12-13 B. = I.7.15-16 K.).⁵⁸ Good living (εὖ ζῆν) is the very essence of ethical philosophy and interestingly the association of Hermes with a whole branch of philosophy is entirely consistent with the way Galen uses Hermes in his Character Traits as a figure who leads human beings to assimilation with the divine after teaching them how above all else to despise worldly pleasures.⁵⁹ The affinities between the two works are symptomatic of a network of cross-references suitably adjusted to the twists and turns in the argument of each text. In addition to Hermes, the insertion of the anecdote about Aristippus, a proverbial model of self-sufficiency in ethical literature (especially in moral diatribes), lends legitimacy to Galen’s ethical production. Aristippus is deployed both in Avoiding Distress, as we have seen, and in Plutarch’s Tranquillity of the Soul, although in the Exhortation Galen provides us with three interrelated stories about him and seems to be drawing on Posidonius’s Protrepticus.⁶⁰

Despite the fact that the paradigm of Aristippus was intended to show that material wealth was something trivial and unimportant to human life,⁶¹ Galen emphasises that many people who found themselves destitute committed suicide (Protr. 6, 91.1-5 B. = I.9.6-10 K.). Presenting opposing attitudes to the loss of possessions points up the extent to which Galen differed from Philides the grammarian, whom he cites in Avoiding Distress as having died of depression caused by the loss of his property, whereas Galen cheerfully continued his normal activities regardless of his own losses in that same disaster.⁶² Galen disapproves of people who neglect their spiritual condition and who are more preoccupied with worldly blessings. He considers them equal to the most worthless slave,⁶³ once again challenging his reader’s sense of honour.⁶⁴

In addition to this, Galen’s moralism starts to take on the acerbic features of Cynic philosophy not only in that it appropriates the opinions of Antisthenes and Diogenes, but above all in that Galen himself is walking in their footsteps when he bitterly attacks rich and uneducated people for falling victim to the self-interest of flatterers:

So perhaps the comparison of such men (i.e. flatterers) to wells is not unreasonable. When a well, which once provided them with water, dries up, people lift up their clothes and urinate in it.⁶⁵

Protr. 6, 92.14-17 B. = I.11.3-7 K.

In similar vein, Galen castigates people who boast of their noble descent, unaware of the fact that their nobility is like the coinage of a state, which has currency with the local inhabitants but is worthless to everyone else.⁶⁶ By making a link to Antisthenes, who is credited with being the originator of the philosophical protreptic,⁶⁷ Galen might be staking a claim to being his emulator and perhaps a reformer of the genre he introduced.

Indeed, besides traits of the Stoic-Cynic diatribe combined with those of the protreptic, Galen’s account features characteristics of mainstream educational works and echoes in particular Plutarch’s On Listening to Poetry.⁶⁸ It is striking, for instance, that Galen quotes both from Euripides’s Phoenician Women (404-405) and Homer’s Iliad (4.405), the most important school texts in that period,⁶⁹ which are also present in Plutarch’s essay, and that he amends poetical lines to make them suit the moral message of his exposition. This is a key pedagogical technique, which Plutarch applies in instructing young readers how they should interpret poetry in a morally upright way and benefit from it as a preliminary stage to philosophy. The recurring use of imperative forms of akouein, a didactic directive that is interpreted to mean not simply ‘hearing’ but also ‘critically considering what is being heard’, is a typical trope in didactic communications, also present in Plutarch’s essay (more on this below).⁷⁰ In discussing the importance of eugenics, Galen argues that noble ancestors instigate a desire to emulate their example,⁷¹ intersecting both verbally and conceptually, for example, with the near-contemporary On the Education of Children, an essay now considered pseudo-Plutarchan, though thought to be authentic in antiquity.⁷² Furthermore, Galen’s emphasis on the emulation of noble exemplars and the severe criticism that he applies to any moral misconduct contribute to his self-depiction as a supervisor of morals, whose role in overseeing and correcting the ethical failings of less experienced agents is crucial, especially in his Affections and Errors of the Soul.⁷³ Finally, Galen’s protreptic on engagement with the arts resembles the introduction to Quintilian’s Institutes of Oratory (1.9-10), a basic educational manual of the Roman Imperial period, which also begins with a protreptic concerning the study of the liberal arts. In the light of the above, we can see that Galen’s Exhortation has a pedagogical character and was intended to have an appeal as an educational text in the transitional stage between secondary education and advanced studies.

In encouraging sensible people to practise the arts, Galen refers specifically to Themistocles as an example of a man who became a significant figure despite his lowly birth on his mother’s side.⁷⁴ The dictum usually attributed to Themistocles survives in Plutarch’s Sayings of Kings and Commanders (187B) and in Stobaeus’s Anthology (4.29.15) where it is attributed to Iphicrates instead. This misattribution may suggest Plutarch’s influence on Galen (see Life of Themistocles, 1.1-4), given that Galen seems to have consulted two other moral works by the same author in this context, as noted above, and presumably also the Life of Solon 22.1 for his Exhortation ch. 8.⁷⁵ Stobaeus (4.29.21-22) informs us that there was a work by Plutarch entitled Against Nobility (Κατὰ εὐγενείας) in which the dictum of Themistocles may have been mentioned, although this remains pure speculation and it is safer to assume that Galen might have drawn on the Life of Themistocles instead.

Be that as it may, the dictum of Themistocles, in addition to discounting the role of noble birth as a factor in ethical propriety, also reinforces the antithesis pride vs. shame that is omnipresent in Galen’s text from the beginning. Galen goes on to link this concept with a key topic in the cultural discourse of the period, namely ethnic identity.⁷⁶ By referring to the case of the Scythian Anacharsis, who was admired for his wisdom despite his barbarian birth, Galen teaches that moral behaviour, an acquired state, raises men above nobility and ethnicity, inherited qualities that are totally beyond their control. That seems to be a persistent issue in his Exhortation, also present in the anecdotes of Aristippus previously discussed.⁷⁷ The Stoics believed that anything that is not ‘up to us’ should not impinge on our happiness (this is their doctrine of the moral ‘indifferents’, as noted above),⁷⁸ but Galen here revises the idea, claiming that what is not up to us should not play a role in any moral evaluation of us:

Once mocked as a barbarian and Scythian, Anacharsis said: ‘my fatherland disgraces me, but you disgrace your fatherland’, a very fine response to a worthless person who gave himself airs solely on the strength of his homeland.⁷⁹

Protr. 7, 95.1-5 B. = I.14.1-5 K.

Galen’s position aligns with the story of the slaves of Perennis used in Character Traits to show that moral integrity is unrelated to social class or education.⁸⁰ Before ending the first part of the essay, Galen raises the issue of beauty and how this can hinder young people from caring for their psychic condition. He employs moral exempla from Solon, Euripides and Sappho, who all agreed that physical beauty did not guarantee happiness but rather threatened it. Additionally, Galen stresses that youth offers only temporary pleasures, and therefore he urges his young readers to develop special regard for the end of their life and appreciate old age.⁸¹ Once more Galen assesses the impact of pre-philosophical/worldly externals, depending on whether they contribute to one’s inner well-being or social adulation: e.g. acquiring money (χρηματισμός) through bodily charm is disgusting (αἰσχρός) and universally despised (διὰ παντὸς ἐπονείδιστος), but the money that comes from art is free (ἐλευθέριος), respectable (ἔνδοξος) and reliable (βέβαιος) (Protr. 8, 98.2-5 B. = I.17.14-17 K.). That helps Galen exhort young men to look in the mirror and try to make their inner morality as beautiful as their outward appearance.⁸² Here Galen is assuming the Socratic persona, as the same counsel is pronounced by Socrates himself notably in 141D of Plutarch’s Precepts of Marriage.⁸³ By neglecting their souls, human agents are only worthy of being spat upon, as the exemplum of the Cynic Diogenes suggests.⁸⁴ Galen filters this through his own protreptic voice:

So, young man, do not allow yourself to become worthy of being spat at, even if you think that everything else about you is splendid.⁸⁵

Protr. 8, 99.16-18 B. = I.19.13-15 K.

It is important to discuss Galen’s authority in the context of his exhortation. His address to young men is informed by a provocatively extravagant, almost paternal, tone: ‘Come then, my children, you who having heard my words have launched yourselves on an education in the arts’ (Ἄγετε οὖν, ὦ παῖδες, ὁπόσοι τῶν ἐμῶν ἀκηκοότες λόγων ἐπὶ τέχνης μάθησιν ὥρμησθε, Protr. 9, 100.1-2 B. = I.20.4-5 K.), which eventually becomes so insistent as to allow little freedom of choice to the young men. This address provides the audience with a sense of security that Galen’s advice will not only protect them against charlatans but to a large extent direct them towards the practice of those arts that are beneficial to life.⁸⁶ Both the appellations Galen uses above (μειράκια and παῖδες)⁸⁷ and the insistent urging to progress to the liberal arts point to the fact that this work is addressed to adolescents around 14 years old, who are about to finish or have just finished their primary education and will now move into general, secondary education (enkyklios paideia)⁸⁸ – a preliminary to any activity in life – with a view to taking up higher studies that will help them secure a noble profession in life, such as medicine.⁸⁹

Finally, Galen also works on the intellectual state of his young readers by subtly putting across the idea to them that the various forms of athletic activity differ from the arts. This he achieves by assuring them that he himself believes in their capacity for discernment⁹⁰ and also by warning them that they need some additional instruction on the crucial issue of athletics.⁹¹ The first section is rounded off in the form of a ring composition with a recapitulatory passage on man’s relationship to gods and animals respectively. However repetitive this might seem to modern tastes, it illustrates the authoritative voice of the author, who communicates his ethical teachings assertively and in plain language, with blunt analogies and conditional clauses, meant to ensure universal applicability to his collective readership of young men:

The human race, my children, has something in common with the gods and the irrational beasts; with the former to the extent that it is possessed by reason, with the latter to the extent that it is mortal. It is better then to realise our kinship with the greater of these and to take care of education, by which we may attain the greatest of goods, if we apply it successfully, and, if unsuccessfully, at least we will not suffer the shame of being inferior to the most idle beasts.⁹²

Protr. 9, 101.2-9 B. = I.21.4-10 K.

The exhortatory register in Galen differs from the mild didactic spirit of Plutarch, especially by comparison with the latter’s two main educational essays, On Listening to Poetry and On Listening to Lectures. Although on the whole all three works address the same concerns about the character development of young people about to embark on their philosophical studies, Plutarch is more philosophical than rhetorical and does not fail to theorise inter alia about the philosophical significance of silence, the role of envy or the power of self-exploration.⁹³ Galen’s rhetorical exuberance, by contrast, directs the reader in a more robust manner, presumably in order to signal more compellingly the need for philosophical engagement. The difference in tone may also tell us something about the authors’ public profiles as perceived by their respective contemporaries or even about the way they wished to be seen by them. Unlike Plutarch, who was well known for having taught philosophy all his life both in Greece and in Rome, Galen was primarily respected as a physician or at best – according to him – as a physician-cum-philosopher. Could Galen’s exuberant rhetoric (partly) hint at his ambitions to become a philosophical luminary in the area of practical ethics?

The dangers of athletics

I now turn to the second part of the essay (chapters 9–14) to show that here Galen inserts even more manipulative material than the merely protreptic sort we have seen in the previous section, and consequently that his tone becomes polemical rather than demonstrative. The author appears to follow the typical division of the protreptic into one section that demonstrates the value of philosophy, education and the arts (ἐνδεικτικόν) and another that refutes inimical arguments against them (ἀπελεγκτικόν).⁹⁴ Nevertheless, in this second part of the Exhortation, instead of testing the validity of the accusations against the arts, Galen demolishes the claims of alternative ideas of success and distinction. More specifically, he levels an attack against hypermasculinity and athletics and rebukes the reader for succumbing to any such wrong choices.⁹⁵ These new topics of discussion have important repercussions for his overarching argument on the practicability and value of ethical philosophy, especially in that they help clarify his view on the attention that should be paid to the care of the soul as opposed to giving excessive attention to the body.

On another level, Galen’s discussion of extreme physical exercise reflects and indeed critically responds to the important part athletics played as a cultural and philosophical field by the second century AD.⁹⁶ Some Imperial-period philosophers tended to advocate the inclusion of gymnastics in the liberal curriculum,⁹⁷ emphasising its benefits for the soul, but in the Exhortation Galen favours medicine at the expense of gymnastics, considering the former an ideal guarantor of physical and mental health, a view that fitted his conceptualisation of medicine as a philosophising area of study and practice. Galen’s attack on athletics has been rightly interpreted as an effective way for him to valorise medicine as an educational discipline in the contemporary health marketplace and consolidate its place in the intellectual setting of the High Roman Empire, thus demarcating his profession from that of athletic trainers, who were men of low educational and social status.⁹⁸ That may well be right, but, as I hope to show, his promotion of medicine must surely be linked to its potential as a social, moralising vocation too.

Abandoning the sociative ‘we’ and assuming the second person indicative or imperative form of address, Galen commences a rejection of athletics in so far as it interferes not so much with the care of the body as with care of the soul. He holds that the most excellent men attract divine praise not for their physical competence but their artistic accomplishments (Protr. 9, 101.12-17 B. = I.21.13-22.3 K.), providing the examples of Socrates, Lycurgus and Archilochus who were all praised by Apollo. In corroboration of this statement Galen interjects a direct aside which is designed to eliminate any hesitation on the reader’s part: ‘If you do not wish to listen to me, at least have some respect for the Pythian Apollo’ (εἰ δ᾽οὐκ ἐθέλεις ἐμοὶ πείθεσθαι, τὸν γε θεὸν αἰδέσθητι τὸν Πύθιον, Protr. 9, 101.21-22 B. = I.22.6-7 K.). Galen’s imposing voice taps into his reader’s religious sensibilities, and a bit further on he accuses the reader of succumbing to popular opinion and going along with the praise of the crowd (Protr. 10, 102.14-17 B. = I.23.3-5 K.), an accusation that seems to be a topos in protreptics.⁹⁹

In continuing his criticism, Galen asks how the reader can arrogantly set himself up as an arbiter of important matters, going against the judgment of men wiser than himself,¹⁰⁰ all of whom have condemned physical training. He elects to quote their opinions, accompanying them with various grammatical forms of the verb akouein.¹⁰¹ This serves Galen’s philosophical aims, because, as we have seen, it can be used in the sense of rationally processing what is being heard after dismissing superficial impressions. It is used in this way in educational contexts, where it can be translated as ‘to consider’, as in this case.

Plutarch’s On Listening to Poetry is again a good comparandum not just in respect of stressing the importance of akouein in the training of young men, but also in that it tackles issues relating to literary criticism, specifically referring to the correlation between poetry and philosophy. In contrast to Plato’s celebrated rejection of poetry on the grounds that it inculcated immorality in young readers, Plutarch adopted its study in his educational agenda, regarding it as a preparatory stage leading into the realm of philosophy.¹⁰² Galen not only seems aware of the tension between poetry and philosophy but also somehow revises this tradition, comparing the two fields on the basis of their opposition to athletics (though of course still prioritising philosophy over poetry). In fact, Galen’s treatment is all the more anchored, given that he is conveying the opinion of medicine too, which also condemns athletics, as the quotations from Hippocrates attest.¹⁰³

Galen’s use of accumulated testimonies from various authorities (especially poetic ones) to argue against athletics, although permissible in morally didactic settings in antiquity, is cast in the text as being at variance with Galen’s authorial principles, since he is anxious to state that he was compelled to resort to such ‘mean activities’ (φαῦλον … ἐπιτήδευμα) so as to benefit those yielding to the vacuities of popular reputation.¹⁰⁴ We have already remarked that Galen employs the argument of ‘compulsion’ when he wants to excuse his denunciation of the moral debasement of others, which often provokes him to respond in self-contradictory ways (Chapter 3). So here too, Galen justifies his use of authorities that distract him from his philosophical role, rendering him a rhetor,¹⁰⁵ by stressing his commitment to the moral incitement of his audience.¹⁰⁶ Such self-apologetics also probably reveal a concern that he may appear more rhetorical than necessary, a common preoccupation of many moral philosophers and a fear Galen also expresses in other works.

In claiming that athletes are totally ignorant of the existence of their souls, busying themselves with flesh and blood matters, Galen depicts them as extinguishing their capacity for contemplation and descending to the level of irrational animals.¹⁰⁷ Identifying athletes with pigs in particular¹⁰⁸ is a technique which helps Galen to relate what he had previously described as the non-rational nature of athletes’ souls to animal behaviour.¹⁰⁹ This brings to mind the similar passage in Character Traits (Chapter 1),¹¹⁰ which equates physical preoccupations with the life of a pig and spiritual concerns with a divine existence. Interestingly, abstaining from immoderate vices, such as over-eating or over-drinking and overindulgence in sexual intercourse, also becomes a crucial part of the profile of the philosophically minded physician in The Best Doctor is Also a Philosopher (e.g. Opt. Med. 290.2-7 Boudon-Millot = I.59.11-15 K.). Galen’s moral narratives clearly compartmentalise virtuous lifestyles, separating them from immoral ones.

Another important aspect in Galen’s exposition in respect of his construction of authority is the relationship he builds between himself and Hippocrates. The abundant Hippocratic quotations in the second section of the essay are not just back-up from an ancient thinker, reinforcing Galen’s medical arguments. Rather they lend persuasiveness to his personal views. That is reflected in the fact that Galen is careful not just to cite but above all to comment on and challenge some of the Hippocratic aphorisms, which ultimately makes a very strong impression.¹¹¹ This is apparent in his use of pertinent vocabulary describing the physical symptoms of an athletic regime¹¹² and in the exposition of the mechanics of the body. That said, this part of the treatise does not get bogged down with any medical trifles, not even deploying any technical terms from physiology, which might confound the inexperienced reader. In chapter 11 for example, Galen provides the reader with a straightforward clarification to explicate a Hippocratic aphorism that involves the distinction between the state and the condition of the body.¹¹³ This indicates that the audience do not yet have any medical background or familiarity with the Hippocratic corpus; otherwise such explanations would have been redundant. That also ties in with Galen’s working method in the Exhortation and elsewhere of carefully adjusting his material to the level of his readers. As he makes clear in a passage in My Own Books, introductory texts cannot be thorough or comprehensive in character, given that beginners fail to comprehend the niceties of the disquisition before first acquainting themselves with the basics (Lib. Prop. Prol. 10-11, 136.9-16 Boudon-Millot = XIX.10.18-11.6 K.).¹¹⁴ This rationale is applied in the Exhortation too, where Galen’s protreptic discourse purposefully omits any hard-core stuff on moral analysis and stays with the simpler hortatory material, as has been observed in the course of this Chapter.

By referring to the athletes’ physical deformities, Galen subverts the notion of their beauty, arguing that their bodily strength is of no significant value other than helping them to perform agricultural activities.¹¹⁵ The sarcastic tone progresses into a compelling assertion that the athletes’ resistance to extreme weather makes them like newborn babies,¹¹⁶ and he mocks them for lying all day long in dust and washing in muck.¹¹⁷ Such polemical comments are meant to undermine the self-esteem of athletes and, in order to conclude that athletics are of no use in any practical context in human life, Galen deploys a didactic myth in verse which preaches that athletic distinction is, in fact, not an accomplishment for humans but for animals.¹¹⁸ This polemical framework reinforces Galen’s concluding thesis that athletics should not even be a way of earning a living¹¹⁹ and so he classifies it in the category of the less-respected banausic arts, unlike medicine which is one of the higher arts, i.e. the ones that can mitigate the bestiality of the soul.¹²⁰ This final remark in the surviving part of the essay shows the ethical dimensions that Galen credits to medicine so as to demonstrate its right to be considered an elevated art. Thus, by urging the reader to adopt a well-defined cluster of habits in relation to the care of body and soul, he corroborates his role as physician but also as a moral mentor for his contemporaries.

Ethics in the Exhortation and in texts focusing on the mechanics of the body

The best constitution of the human body and its hygiene and physical exercise are vital issues in Galen’s naturalistic thought, which he discusses in a group of technical works.¹²¹ In this section, I would like to explore briefly some cases of material common both to these works and the Exhortation in an attempt to illuminate Galen’s moralising twists in the latter and further stress how his ethical pronouncements require subtle transformations in order to resonate with his young audience and the requirements of his philosophical exposition.

The first example comes from the short essay Good Condition. Here Galen examines the definition of ‘good condition’ in cases where reference is made to an individual’s nature, suggesting that one should always add the name of the person, for instance ‘Dion’s good condition’ or ‘Milo’s good condition’.¹²² Milo of Croton was a well-known wrestler of the sixth century BC (considered a follower of Pythagoras), whom Galen compares in this context to Hercules and Achilles, both representing positive cases of good condition in the unqualified sense. However, subsequently he twice adduces the authority of Hippocrates to warn against extreme bodily states: ‘Among people who take gymnastic exercise, the extremes of good condition are dangerous’ and ‘The athletic state is not natural; better the healthy condition’.¹²³ Both of these Hippocratic statements each occur twice in the Exhortation,¹²⁴ and Hercules too is used here as a positive model of physical resilience (Protr. 13, 112.3-7 B. = I.33.9-13 K.). In the Exhortation, however, the figure of Milo is treated in the most negative fashion, as Galen devotes a remarkable amount of space to showing that Milo’s physical achievements were a manifestation of incredible stupidity (ὦ τῆς ὑπερβαλλούσης ἀνοίας, Protr. 13, 112.17-18 B. = I.34.5 K.), linked to the hero’s servile sacrifice of his soul (Protr. 13, 112.15-114.4 B. = I.34.3-35.11 K.), which Galen calls ‘worthless’ (οὐδενὸς ἦν ἀξία, at Protr. 13, 113.4 B. = I.34.9-10 K.). Moreover, Galen depicts Milo as devoid of rationality, making his approach to life appear useless by comparison with Themistocles’s wisdom.¹²⁵ Those reconfigurings evince Galen’s moralising input in his Exhortation, a text concerned with distancing its young readers from an excessive preoccupation with the body.

Galen’s interest in depicting physical exercise through an ethical lens is also seen in The Exercise with the Small Ball, where again the degree of moralising is restrained by comparison with the Exhortation. This essay is addressed to Epigenes, a man of superlative physical condition, to whom our author proposes the most superior kind of physical activity, i.e. exercise with the small ball. The precise nature of this sport is unclear,¹²⁶ but it is telling that Galen embraces it because it does not just exercise the body, but above all delights the soul.¹²⁷ Elsewhere, he stresses that this form of exercise assists both body and soul to achieve their respective best state,¹²⁸ a recurrent motif in the essay, which eventually confirms the soul’s superiority over the body.¹²⁹ By contrast, Galen condemns wrestling on the grounds that it renders the intellect idle and sleepy, promoting body-building rather than the cultivation of virtue.¹³⁰ In this connection, Galen claims that if one engages with wrestling, one’s chances of a brilliant generalship or political power are minimal and that it would be better to assign such public duties to pigs than to wrestlers.¹³¹ The material here echoes a certain passage from the second part of the Exhortation where, as we have seen, Galen remonstrates with athletes for their body-building on the grounds that it extinguishes their rational capacities and renders them pigs.¹³²

Thus Galen reworks very similar material in the moral context of the Exhortation but in a manner that makes his argumentation more powerful, especially through the use of more direct condemnation devices. The retexturing patterns also show that Galen’s value of philosophical moderation in relation to the care of the body is a principal feature of his moralising medicine, which controls all other types of bodily knowledge. That is quite clear, for instance, in his Matters of Health, a work dedicated to hygiene but not free from moral overtones (Chapter 3). In a series of recommendations on physical health for adolescents, Galen again strikes a balance between lack of exercise and extreme gymnastics and emphasises how this balance impacts on a young man’s character formation, ensuring both orderly behaviour (εὐκοσμία) and ready obedience (εὐπείθεια).¹³³

Comparable retexturing patterns occur in another work concerned with the care of the body, namely Thrasybulus: Is Healthiness a Part of Medicine or of Gymnastics? As the work’s title suggests, the topic under examination is very close to that addressed in the second part of the Exhortation, yet Thrasybulus is more of a technical work undermining the value of gymnastics via logical demonstration.¹³⁴ Galen’s main thesis is that gymnastics is a perverted art, which has nothing to do with healthiness, concluding that it has justly attracted the contempt not only of Plato and Hippocrates but all other doctors and philosophers. Through vigorous interrogation, Galen eventually triumphs over his addressee, Thrasybulus, despite the latter’s philosophical propensities and inquisitive spirit. The assertive imposition of authorial intent also provides the framework for the Exhortation, although to a completely different end, as we are dealing with Galen’s moral didacticism towards a lay young audience here, not his promotion of logical practice for a group of intellectually advanced and demanding addressees.

The work’s contextual framework: Commodus attacked?

Before concluding, I would also like to discuss the contextual setting that may have inspired the composition of the Exhortation and provide a possible explanation for the polemic Galen launches against athletics in the second half of the tract. From the early years of his professional career, right back when he was appointed physician to the gladiators in Pergamum in ca. 157 AD, Galen appears to have been an ardent supporter of physical well-being and recovery.¹³⁵ Autobiographical descriptions show how upon moving to Rome he continued his own bodily care and devoted himself to wrestling until a severe injury in 164 AD obliged him to turn to less extreme forms of exercise.¹³⁶ The event in his career that may have made him reconsider the role of athletics might have been his personal supervision of the training of the young Commodus,¹³⁷ who, overwhelmed by Imperial wealth, his own beauty and bodily strength, resorted to the savagery of the Roman gladiatorial combats and despised the philosophical legacy of his high-minded father, Marcus Aurelius. The three factors that Galen castigates in his Exhortation as promoting the debased spirit of athletics, namely wealth, origin and beauty, are interestingly those that led to Commodus’s eccentric participation in the arena, according to the contemporary historian Cassius Dio (Roman History 72.7.4).

Cassius’s narration offers a lucid prosopography of Commodus that has striking similarities with Galen’s portrait of the athletic man. As Cassius repeatedly states (Hist. Rom. 72.7.1, Hist. Rom. 72.18.3-4), his report was the result of what he had seen for himself, which makes us wonder whether Galen was an eyewitness to the same events, especially in light of the affinities we notice between the two accounts. The Roman historian explains that Commodus became a slave to lustful and cruel habits due to his ignorance, which prevented him from living the good life (Hist. Rom. 72.1.1). Galen similarly condemns athletes for surrendering to bodily pleasures and ignoring the existence of their souls and the importance of moral virtues (Protr. 11, 106.1-7 B. = I.26.17-27.6 K., cf. Protr. 6, 91.16-22 B. = I.10.2-8 K.).¹³⁸ In describing Commodus’s public combats with wild beasts and gladiators (Hist. Rom. 72.102-3), Cassius mentions that the emperor wished to be called a Roman Hercules, and statues were erected representing him as such (Hist. Rom. 72.15).¹³⁹ Drawing on the Commodus–Hercules propaganda that was pervasive in the late second century AD, in the Exhortation Galen refers derogatorily to the ‘emulators of Hercules’ (Protr. 13, 112.4 B. = I.33.9-10 K.), mocking specifically their physical feebleness (Protr. 13, 112.5-7 B. = I.33.1-13 K.). Driven by his eccentricity, Commodus used to enter the amphitheatre in the garb of Hermes, carrying the god’s staff (Hist. Rom. 72.17.3-4, Hist. Rom. 72.19.4), and demanded that his reign be called the ‘Golden Age’ (Hist. Rom. 72.16.1). These details align with Hermes’s role in the proem to the Exhortation and, if I am right in my suggestion that Galen is alluding to Commodus, then he is hinting at the emperor’s deluded state of mind, given that his crimes set him apart from Hermes, who is the personification of virtue in Galen’s account (Protr. 3, 87.7-9 B. = I.5.2-4 K.). Commodus’s vice and depravity also dissociate him from the Golden Age, conventionally seen as a period of primitive wisdom and ethical righteousness.

Galen’s criticism of athletes might therefore be seen as an allusive commentary on the misbehaviour of the young emperor, probably reflecting similar public responses,¹⁴⁰ and more generally on the elevated position that athletes enjoyed at his Imperial court. Galen’s tacit approach is probably because he feared for his life amidst the ongoing turmoil and instability, since the Exhortation must have been written during the three-month reign of Pertinax (1 January 193 – 28 March 193 AD) that followed the assassination of Commodus, as Joseph Walsh suggests.¹⁴¹

On another level, Galen’s acquaintance with Imperial athletics must have made him oppose the unnatural ways in which athletic coaches attempted to create strong bodies. It was often the case that trainers entered the territory of medicine without having the necessary medical skills or background. This might explain why Galen so strongly adduces the authority of Hippocrates in his polemic against athletics: it reflects his attempt to demarcate his genuine medical status from that of charlatans. It is also important how Galen’s stance reflects contemporary cultural trends that associated the intense practice of athletics with a lowering of ethical standards. In the third century AD, Philostratus composed a manual for athletic coaches, which highlighted the pressing need for them to be knowledgeable about medicine, especially anatomy and eugenics, and at the same time to despise corruption, in line with the old system of gymnastics that produced praiseworthy men such as Milo and Hercules. Galen’s Exhortation makes, as I have shown, a markedly moralising appeal to readers both in terms of direct admonition and of social critique. The latter is employed most prominently in Recognising the Best Physician and Prognosis, which I shall discuss in forthcoming Chapters.

Conclusions

In one of his Discourses (‘On rhetorical display’, 3.23.33-38) Epictetus holds that the philosophical protreptic differs from epideictic oratory in that it does not set out to give the audience pleasure but to expose their moral weaknesses, often in crude ways. The protreptic, he goes on, is the most suitable form of exhortation the philosopher can use to induce self-realisation. In this Chapter, I hope to have shown that Galen’s Exhortation is not a conventional epideictic piece as Epictetus understood it,¹⁴² but one in which rhetoric to a large extent facilitates philosophical instruction. As I have tried to show, the work abounds in educational elements, which are consistent with its more developed moralising by comparison with what we get in other works treating the mechanics of the body. We have also seen how Galen’s authority imposes itself on what he expects to be an inexperienced, young audience in an attempt to initiate them into some of the tenets of philosophical training with a view to leading them to study medicine. This accounts for Galen’s avoidance of theoretical and technical material, which is replaced by practical counsel instead. Here readers are not active agents as they are in Avoiding Distress, they are not informed of the personal testimonies of the Galenic narrator, nor do they enjoy any interpersonal relationship with their instructor as yet. The function of Galen’s protreptic is less to develop independent thought than to arouse desire for imitation, eliminate erroneous impressions and provide safe choices to young people moving from literary and rhetorical studies to a philosophical education, ideally with a view to becoming physicians later.¹⁴³

The Socratic protreptic entails elenctic admonition, Aristotle’s (fragmentary) protreptic elaborates arguments and has a concluding peroration, Seneca’s protreptic is an epistolary refutation of Posidonius, while that of Iamblichus is an anthology of protreptics in the form of exegesis. Galen’s protreptic is of a different sort, not only in that it is an authoritative monologue verging on a traditional diatribe, but mostly because of its peculiar moralising rhetoric, which seems to cast a wide net, thus making it a public rather than an intimate piece. Its scope is also significant because of its close interplay with a large number of philosophical sources, not just the later Stoic tradition, represented by Posidonius and Seneca, but also with the Platonic and Aristotelian legacy, and most notably Plutarch. It is this richness and the diversity of Galen’s treatment of moral issues that makes him stand out in ancient philosophical culture. The Lamprias catalogue, an ancient list of Plutarch’s works, informs us that Plutarch himself produced two protreptics, An Exhortation to Philosophy, Addressed to a Rich Young Man (no. 207) and An Exhortation to Philosophy, Addressed to Asclepiades of Pergamum (no. 214), both of them lost. Attempting to prove that Galen’s Exhortation drew on these two works must surely remain a matter of speculation, but, on the basis of the other close parallels shared between the two authors, I hope at least to have made attractive the possibility of Galen trying to enter the moral tradition that Plutarch inherited and enriched, and to enjoy (some of) the latter’s popularity as a star moralist of the Graeco-Roman period. Even if Galen’s closeness to Plutarch is not conscious or direct (which I think it is), it does have something to tell us about the former’s sustained work in the area of moral philosophy and its envisaged impact on the contemporary philosophical and intellectual landscape.

Chapter 6 Affections and Errors of the Soul

The Affections and Errors of the Soul has a prominent position among Galen’s works on moral philosophy.¹ First of all, it is sufficiently extensive to illuminate the author’s multifaceted moral agenda in what seems to be a popular philosophical treatise in the strict sense of the term. Moreover, it reveals a lot about the moral milieu of the second/third century AD, widening its scope from a particular ethical situation to cover such aspects as the sociology of moral passions and their aesthetic evaluation. In addition, it sheds light on the relationship between medicine and practical ethics through its focus on what I shall term ‘ethical’ case histories. Relatedly, it shows the intricate ways in which Galen, putting aside his medical role and assuming the persona of a moral practitioner, leverages standard ethical ‘psychotherapeutics’, at times simply pressing them into service and at others transforming them, to meet the moral needs of his audience and, of course, the principles of his ethical programme.

Previous discussions of this text have explored Galen’s philosophical leanings or influences with reference to psychic affections and errors² or have used them as a springboard to a wider treatment of Galen’s pathology of the soul.³ Little has been done to foreground the work’s moralising weight as outlined above or the authorial strategies employed to encourage readers to cultivate an ethical approach to life. The aim of this Chapter is to situate Affections and Errors of the Soul in the larger picture of Galen’s practical philosophy and cast light on the special characteristics of his moral practice.

Constructing the identity of a moral philosopher: Polemic, self-promotion and self-effacement in the proem

The Affections and Errors of the Soul, like the other extant moral pieces by Galen, was composed after 192 AD, the year marking Commodus’s death, and it is divided into two books, the first one dealing with affections, the second with errors. This distinction reflects the text’s main philosophical thesis that drives the argument from the outset, namely that errors (ἁμαρτήματα) result from the soul’s rational part, being erroneous judgments, whereas affections (πάθη) spring from the non-rational part, every time it fails to subject itself to reason.⁴

One of the most salient features of the preface to the Affections and Errors of the Soul is the multiplicity of stages through which Galen builds up his authority in the realm of ethics. The work begins with a reference to the occasion for which the work was written. This takes the form of a micronarrative, whose components Galen tailors to present himself as an expert in the subject under investigation. Inspired by a common trope in writings on the therapy of the emotions, he introduces an anonymous, fictional addressee, who has supposedly requested a written note on the oral response Galen had made in public to his question about the Control of One’s Own Particular Affections by Antonius the Epicurean. The constructed time and space in the micronarrative operate on two levels and suggest two interrelated things: the ‘past moment’ alongside the ‘oral disquisition’, on the one hand, imply that the addressee was a frequent participant in Galen’s public lectures, thus inviting us to visualise Galen talking about ethics in front of large audiences. The ‘present moment’ and the ‘written text’, on the other hand, suggest Galen’s success in the oral performance and hence justify the addressee’s long-standing interest in Galen’s ethical expositions, this time leading us to imagine Galen at his desk writing down⁵ the philosophical substance of his lecture that his followers so ardently demanded.

Two further elements in the preamble buttress Galen’s self-legitimacy and self-promotion. First, the recipient of the essay is never given a name, which points to the fact that he might represent a wider readership, thereby corroborating the impression we get from the text regarding Galen’s popularity as a moral specialist. Second, we know nothing about Antonius or this specific work by him,⁶ which might suggest that he was of lesser importance or reputation in antiquity than the successful Galen as delineated in the narrative so far.

In fact, Antonius’s presence in the text is not without further significance. Galen sets up a critical dialogue with him, castigating in particular his inaccurate use of terminology: ‘It would have been best if Antonius had himself stated clearly (εἰρηκέναι σαφῶς) what he means by the term “control”’ (Aff. Pecc. Dig. 1, 3.8-9 DB = V.1.5-7 K.) and further on ‘It also became apparent, as you know (ὡς οἶσθα), that he [i.e. Antonius] was <confused> and unclear in his interpretations (ἀσαφῶς ἑρμηνεύων), <so that> most of his statements are susceptible to conjecture rather than to clear understanding (νοῆσαι σαφῶς)’ (Aff. Pecc. Dig. 1, 3.11-13 DB = V.2.3-5 K.).⁷ Here Galen enters the area of philosophical exegesis and takes on the role of a skilled commentator, whose duty is to decipher hidden meanings and provide clarity on philosophical notions of primary importance.⁸ That is indeed his main activity in his commentaries on Hippocratic works, but also a basic trait of his scientific methodology and medical writing more broadly, encapsulated in his motto ‘clarity of exposition/instruction’ (σαφὴς διδασκαλία). That explains why Galen goes on to carefully define affections and errors, and why he maintains a tendency throughout this work (as elsewhere) to offer well-defined terms and classifications. Galen’s implication in the statements cited above is that, unlike himself, Antonius is a philosopher of ill repute, who has dealt ineffectively with the mastery of the passions. Through the subtle use of the aside ‘as you know’ (ὡς οἶσθα) Galen projects onto his addressee and implied audience his own perspective on Antonius’s minimal abilities.⁹

Galen’s criticism of Antonius’s deficient methodology progresses into a more robust polemic as the text unfolds.¹⁰ Galen tells us that in the light of a primary reading of Antonius’s work, he thinks that by ephedreia Antonius might be referring to either surveillance (παραφυλακή) or diagnosis (διάγνωσις) or correction (ἐπανόρθωσις), but ends up admitting to complete bafflement. He also explains that his main issue with Antonius is that within the context of the same work he sometimes urges his readers (προτρέπειν) to realise their errors, while elsewhere he focuses on the diagnosis of individual errors, and at other points advises on how to abstain from them (Aff. Pecc. Dig. 1, 3.10-17 DB = V.2.1-9 K.). This division corresponds to some extent to the threefold typology of works of practical ethics, made up of protreptic, therapy and advice.¹¹ And, that being so, Galen’s condemnation of Antonius rests on the fact that the latter has made grand claims in the area of popular philosophy, which had led him indiscriminately to include all subcategories of practical ethics within the same work, resulting in the lack of clarity Galen accuses him of above. We might wonder how reprehensible such cross-fertilisation really was, especially in an age in which we now know generic classification was not as rigid as we once believed it to be.¹² Still, according to Galen, in Antonius’s case this counts as a fatal mistake, which sanctioned his own attempts at producing a proper work on ethics. This seems to be a common Galenic move, as in Anatomical Procedures our author declares that he has penned this work as a response to Marinus’s incomplete and obscure treatment of anatomical observations, which no other author had yet managed to improve upon (AA 2.2, 73.18-22 Garofalo = II.283.7-12 K.; AA 4.10, 263.7-10 Garofalo = II.470.12-16 K.).¹³

Galen ends his series of attacks on Antonius by making a direct comparison between himself and his rival, in which, in the mode of self-praise, he congratulates himself on making a clear distinction between affections and errors, something that Antonius had so obviously failed to do (Aff. Pecc. Dig. 1, 3.20-4.7 DB = V.2.11-3.5 K.). Antonius is outmatched, and so Galen now turns to the ancient philosophers who had composed therapeutic writings on moral passions (θεραπευτικὰ γράμματα τῶν τῆς ψυχῆς παθῶν, Aff. Pecc. Dig. 1, 4.9 DB = V.3.6-7 K.), namely Chrysippus but also Aristotle, his followers and Plato before them.

Implying that Antonius was not well versed even in this long-standing psychotherapeutic tradition, Galen says that ‘[i]t would have been better to learn these things from these people [i.e. the earlier authorities], as I did’ (Aff. Pecc. Dig. 1, 4.11-12 DB = V.3.9-10 K.). He therefore wins the day once more. However, this is the concluding section of the preface and, given its emphasis on his (progressively developed) egocentric image, I would argue that this final remark goes beyond Galen’s antagonism to Antonius, in hinting at something crucial about his own relationship with his predecessors. Galen, in his usual mode of self-effacement, pretends to be merely a modest student of the ancients, whereas in reality he is himself producing a new ethical work to advance the ancient tradition. His close conversation with his precursors is not an open or fierce one as with Antonius, but it can still be suggestive of what he deemed to be his high philosophical achievements in the field of ethics.¹⁴

To support this argument, I shall turn to an intriguing section which happens to be the concluding part of the second book On Errors, hence forming a kind of ring composition in Galen’s programmatic strategy (Aff. Pecc. Dig. 7, 65.16-68.18 DB = V.98.9-103.16 K.). Here Galen professes to despise philosophers who make rash declarations without using logical demonstration and criticises them for pretending to know the truth of things, when they are actually ignorant. In this context, he introduces a brief embedded narrative, in which he is not just the author and narrator, but also the protagonist. The story stages a debate on whether water is heavier than wood, very reminiscent of a Platonic discussion or of Plutarch’s sympotic episodes in his Table Talk, to give a more contemporary counterpart. The other participants are two philosophers and an architect, all of whom Galen has outshone in philosophical rigour by the end of the account, thus preserving his standing as the leading character. What seems to equip Galen with philosophical impact is his unique grasp of all major theories on the issue of the cosmic void, including Peripatetic, Stoic and Epicurean explanations, unlike his competitors who cannot measure up to Galen’s wide-ranging knowledge. Consequently, Galen’s self-presentation as a distinguished philosopher rests on his self-assertion that he is an active discussant with second-century rivals as well as past intellectual authorities, as suggested in the conclusion of the proem to the Book on Affections.¹⁵ That also ties in with Galen’s independent views elsewhere that Second Sophistic authors should consider being heirs to a long tradition a great advantage (οὐ σμικρὸν ἦν πλεονέκτημα), as this puts them in a position to emulate that tradition and potentially surpass it.¹⁶ The same credo shines through in an authoritative passage from Therapeutic Method, where Galen resolutely declares he has ironed out Hippocrates’s shortcomings in analysis and exposition, comparing his feat to Trajan’s impeccable road-building programme in Italy (MM 9.8, X.632.1-634.3 K.). Far from being a derivative replication of the past, antiquarianism provides serious opportunities for individual merit and impact.

The preface to the Affections and Errors of the Soul, then, is intended to carve out a niche for Galen as a key figure in the area of popular philosophy. It reflects his ‘anxiety of influence’¹⁷ in relation to both current and earlier philosophical writers. We have seen that our author strategically presents the recipient of his essay as a follower of his philosophical talks and attentive enough to deliberate on ethical matters that he needed Galen’s scientific contribution to ethics. The recipient is even depicted as maintaining an interest in Galen’s oral accounts and requesting written records thereof, hence confirming Galen’s accomplishments as a moral authority by comparison with earlier and contemporary philosophers. This picture is created in two ways in the text: through explicit criticism of Antonius and blatant self-advertisement, and by means of a less direct dialogue with the ancients, this time realised through a rhetoric of modesty.

Genre and level of addressee

Before examining Galen’s moralising approach in more detail, it would be helpful to briefly analyse the Affections and Errors of the Soul as a textual entity. I have already mentioned that this is a treatise belonging to the popular philosophical tradition of the Roman Imperial period, but the work itself provides further indications about its generic identity. First, it is made clear that the author is not interested in expounding the minutiae of an abstract psychopathology as in his Character Traits. This is obvious in chapter 6, where, in the context of a brief technical digression, Galen cross-references Character Traits as a fuller account of the soul’s constitution and especially of the method of disciplining its two non-rational capacities (Aff. Pecc. Dig. 6, 19.8-20.19 DB = V.26.17-29.15 K.). In addition, the psychological ‘jargon’ that Galen uses here is consistently glossed for the addressee’s sake,¹⁸ on the assumption that he has no prior familiarity with it. Galen does not even expect his recipient to be aware of the fact that the desiderative capacity, if uncontrolled, can turn into bodily lust (Aff. Pecc. Dig. 6, 20.19-31 DB = V.29.15-30.3 K.). Consequently, the author is less concerned with communicating expert knowledge on ethics and more with offering moral admonition in order to incline his recipient towards a life of moderation. In view of the above, the scholarly argument about Galen’s ‘lexical poverty’ in relation to the terminology of the pathē¹⁹ is not justifiable, at least as regards his popular philosophical essays, if one bears in mind that the aims and character of this group of texts were primarily pragmatic and accessible, rather than theoretical and jargon ridden.

Secondly, the text also suggests that the addressee seeks hands-on tips on how to become virtuous, once he has acknowledged his moral flaws. This is evinced in Galen’s remarks that this work is not a protreptic seeking to exhort people to virtue (οὐ γάρ ἐστι προτρεπτικὸς ἐπ᾽ ἀρετήν), but rather aims to show those who are already going in that direction the path by which they can attain it (ἀλλὰ τοῖς προτετραμμένοις ὑφηγητικὸς τῆς ὁδοῦ, καθ᾽ ἣν ἄν τις αὐτὴν κτήσαιτο, Aff. Pecc. Dig. 6, 23.14-16 DB = V.34.5-7 K.). Galen’s use of the sub-genre of the hyphēgētikos seems to conform both to the group of Platonic dialogues labelled as ὑφηγητικοί (useful for guidance), as opposed to ἀπορητικοί or ζητητικοί (i.e. enabling investigation);²⁰ and partly to the notion that the ὑφηγητικός can take the ἠθικός as its practical example.²¹ Galen’s work is therefore targeted at those who are aware of their need for moral development and have consciously opted for it (τοῖς βουληθεῖσιν, Aff. Pecc. Dig. 7, 24.3-4 DB = V.35.1-2 K.).²² Boulēsis (volition) is of special interest, as it verges on prohairetic choice, indicating the agent’s determination to achieve emotional equanimity. In this and similar contexts, however, it also points to Galen’s conceptualisation of moral philosophy as being useful to and achievable by everybody who wishes to exercise it, a notion stressing the universal attainability of moral wellbeing proclaimed in My Own Opinions.²³ The necessity for self-knowledge on this self-conscious course is developed at length in chapter 2, to which I now turn.

Self-knowledge vs self-love

This section explores how the agents’ self-love obstructs their self-knowledge, with Galen frowning upon egotists who are unable to understand what they are doing wrong. One way to persuade his readers of the importance of the point he is making is by introducing his personal experience of the phenomenon through the use of verbs of vision and observation (ὁρῶμεν, ‘we see’; παμπόλλην ἔσχηκα πεῖραν, ‘I have had a great deal of experience’; ἐθεασάμην, ‘I have observed’, ἑώρακα, ‘I have seen’, all featuring in Aff. Pecc. Dig. 2, 4.17-25 DB = V.3.16-4.7 K.). This recalls the stress Galen places on personal experience as a means of validating his ethical authority in other moral works (Avoiding Distress, chapter 4). But it also helps demonstrate Galen’s individual input into the discussion of self-love compared with how the topic was conducted by other thinkers in earlier antiquity. In adopting the well-known quote from Plato ‘the lover is blind regarding the loved one’²⁴ (Aff. Pecc. Dig. 2, 6.7-9 DB = V.6.8-9 K.), which also often features in Plutarch’s moral works²⁵ – Galen’s most probable source, given that the quotation does not appear in any other earlier or (near)-contemporary author²⁶ – Galen departs from his intellectual antecedents and embarks on a revisionary understanding of self-love, which is no longer negatively loaded (as being an obstacle to moral improvement), but rather signifies a genuine love of the self, a self-determined desire to really be kalos kagathos and not just appear to be (Aff. Pecc. Dig. 10, 37.19-21 DB = V.56.16-57.1 K.).

The most remarkable technique that Galen employs, however, in his discussion of self-knowledge and self-love is the use of reference groups to create a sort of ‘class fraction’, directing the reader’s behaviour. The starting point of this is found in Galen’s reproachful statement that many people are reluctant to accept criticism from others, which leads him to explain why readers should act differently. ‘Class fraction’ is then employed on three more levels:

1. a) In the distinction between immature youth and wise adulthood. This is demonstrated in Galen’s personal confession that, when he was young, he would question the validity of the Pythian motto ‘Know yourself’, but later, as he reached a state of maturity, he eventually embraced it (Aff. Pecc. Dig. 2, 5.1-3 DB = V.4.8-10 K.). Galen here puts on the cloak of a role-model by revisiting his earlier views on issues of morality, hence inviting his audience to have the same degree of acumen, acceptance and flexibility in their moral judgments.²⁷ As we will see later on in this Chapter, Galen is keen to advertise his moral character to quite some extent, as this was an essential attribute of philosophical authority in the Imperial period, especially through the philosopher’s anticipated role as pioneer and champion.²⁸

2. b) In the dichotomy between the wisest of men, who is the only one capable of knowing himself, and all the rest who are simply incompetent and unable to do so (Aff. Pecc. Dig. 2, 5.3-5 DB = V.4.11-13 K.). Perhaps referring to the ideal of the Stoic sage, this dichotomy is not developed any further by Galen, because he does not as a rule offer models that are beyond the reach of most men.

3. c) The divide between the common herd on the one hand and discerning or skilled men on the other, with the former making sense only of broad distinctions in life and art, whereas the latter grasp all the subtle differences therein (Aff. Pecc. Dig. 2, 5.5-9 DB = V.4.13-17 K.).²⁹

I am using the term ‘class fraction’ in relation to Galen’s moralising argumentation based on Pierre Bourdieu’s theory of ‘class fraction’ or ‘class distinction’. This theory holds that the way people present their social space determines their status in society and sets them apart from lower groups through clear-cut social separation. Bourdieu’s theory rests predominantly on the aesthetic predilections that people (especially young ones) internalise to the point of making them deeply-rooted dispositions. However, his theory also covers other ‘symbolic goods’ that combine social, economic and cultural capital. As he posits, ‘symbolic goods, especially those regarded as the attributes of excellence, constitute one of the key markers of “class” and also the ideal weapon in strategies of distinction …’.³⁰ Moral habitus, in the sense of developing and developed ethical patterns, may be seen as another such symbolic good in Galen, given that any moral tastes other than those embodied or proposed by him are presented as deviant and are thus likely to provoke rejection, and, as we will see, laughter, contempt or disgust.³¹

Indeed, ‘class fraction’ in Galen does not only encourage the audience to espouse proper morals, but also establishes his role as an expert in the study of the soul. There is an arcane mention in the ensuing text of someone who is depicted as being able to distinguish between obvious passions (e.g. irascibility, promiscuity) and less obvious ones (moderate perturbation, slight overeating) and perceive their intensity depending on the way they are acted out. This man’s discerning abilities are said to rely on a preliminary understanding of issues relating to the soul (προμελετήσαντι τὴν ψυχὴν) and an associated aptitude to deal with the rectification of passions (ἐξοδιάσαντί <τε> ἁπάντων παθῶν ἐπανορθώσεως) (Aff. Pecc. Dig. 2, 5.9-16 DB = V.4.17-5.10 K.). It is not unreasonable to see this as a veiled reference to Galen and his morally didactic role so far. This proposal is consistent with the way Galen goes on to advise specifically ‘the person who wishes to be a decent human being’ (ὅστις οὖν βούλεται καλὸς κἀγαθὸς γενέσθαι, Aff. Pecc. Dig. 2, 5.18 DB = V.5.10 K.), with καλὸς κἀγαθός being a metatextual label, constituting the cornerstone of moral essays both as a specified topic under investigation and a philosophical desideratum in social and political life in the ancient world. The suggestion also accords with Galen’s subsequent admission that he has already discovered himself and his individual mistakes, having thus transcended the passions he lectures on for others. As we have seen in Avoiding Distress (Chapter 4), it is Galen’s positive experience with tormenting passions that puts him in a position to guide others on similar issues through his works.

In fact, even though Galen emphasises the need for moral knowledge and the exercise of the intellect in the regulation of passions,³² in what follows in this section he refrains for the present from giving a relevant account, because, as he explains, his book may at some point be transmitted to others and so he prefers to leave them ‘first to be schooled in the discovery of the path to knowledge of their own errors’ (ὅπως ἂν κἀκεῖνοι γυμνασθῶσι πρότερον ὁδὸν εὑρεῖν τῆς γνώσεως τῶν ἰδίων ἁμαρτημάτων, Aff. Pecc. Dig. 2, 5.21-23 DB = V.5.13-16 K.). This has two implications: firstly, that the unnamed addressee indeed stands for a general readership, as previously argued; secondly, that Galen does not wish to provide processed material for immediate use, but rather to offer opportunities for moral gymnastics, as it were, pointing to the necessity for self-motivated ethical training. In addition, what is highlighted in the relationship between Galen and his audience is the discreet distance he chooses to keep as an ethical mentor, in order to allow the active involvement of the moral agent:

So, just as I suggested that you tell me, and listened in silence while you declared what seems to you to be the case, I will now do the same, exhorting the reader of this piece of writing to reflect on it and enquire how one may gain the ability to recognise when one is oneself committing error.³³

Aff. Pecc. Dig. 2, 5.23-6.3 DB = V.5.16-6.3 K.

Moments of silence are always important for self-reflection in philosophical settings, especially in teacher-pupil dynamics.³⁴ Plutarch, for example, in his convivial dialogues argues that a lapse into silence can have two different responses in two different groups of attendees: idle and untalented participants (ἀργοὺς καὶ ἀφυεῖς) feel relaxed and satisfied during a silent interval, whereas those who are ambitious and scholarly (τοῖς δὲ φιλοτίμοις καὶ φιλολόγοις) use it as an opportunity to make their own attempt to seek and track down the truth (ἀρχὴν ἐνδίδωσιν οἰκείαν καὶ τόλμαν ἐπὶ τὸ ζητεῖν καὶ ἀνιχνεύειν τὴν ἀλήθειαν) (Quaest. Conv. 694D). So, just as on a textual level, in the mode of a Socratic teacher, Galen propagates the idea of time for discreet self-contemplation, in the same way on a meta-level he allows time for an active, self-introspected reading of his piece.³⁵

Later in the work Galen stresses how tricky internal investigation can really be and so he asserts that, if each individual finds some other way of identifying personal mistakes, he may add it to Galen’s method and benefit from having two ways of salvation instead of one; otherwise, he can stick to Galen’s suggested method until he finds a better one (Aff. Pecc. Dig. 2, 6.16-24 DB = V.6.17-7.9 K.). It is clear that Galen’s aim is to encourage self-alertness and independent scrutiny in the area of ethics, so as to foster the agent’s energetic participation in his moral overhaul. Interestingly, when it comes to the area of the intellect, Galen significantly restricts the reader’s exploratory possibilities: in Book 2 On Errors, which is much more self-assertive in tone than Book 1 on Affections, he proclaims that he has found just one way of investigating truth and that he is convinced that this is indeed the only way (Aff. Pecc. Dig. 2, 45.20-23 DB = V.66.1-4 K.).

The figure of the moral supervisor

In the Affections and Errors of the Soul, Galen devotes a significant amount of space in the text to the figure of the moral supervisor, who is tasked with providing candid critique and exposing any moral frailties escaping the notice of those who commit them.³⁶ The personal advisor as psychagogue helps overcome any such barriers to a good life and is therefore a strategic instrument of moral improvement in Galen’s text. Though treated by other thinkers as a general principle appreciated by philosophical learners in the Graeco-Roman world, Galen specifies some of this figure’s defining features: he should be someone to whom the agents are emotionally indifferent (viz. someone who is neither hated nor loved by them) and should act mainly when self-love clouds self-knowledge, as seen in the previous section.³⁷

Before turning to the actual relationship between advisor and advisee, however, Galen inserts a short theoretical precis on passions, in order to show why it is important to free ourselves from them. Here he conceptualises passions as arising from non-rational impulses, but to some extent he also connects them to mistaken beliefs. This most likely points to a blending of the Platonic/Aristotelian stance on the dual constitution of the soul on the one hand, whereby the non-rational faculty unduly prevails over the rational, giving rise to passions,³⁸ and the Stoic understanding of emotion theory, relying on monism, on the other, whereby the soul is entirely rational and passions are therefore seen as misguided judgments.³⁹ The Stoic influence is further attested in Galen’s ensuing listing of passions, namely rage (θυμός), anger (ὀργή), fear (φόβος), distress (λύπη), envy (φθόνος) and vehement desire (ἐπιθυμία σφοδρά),⁴⁰ which is by no means far removed from the Stoic taxonomy of four cardinal passions: desire (ἐπιθυμία), fear (φόβος), delight (ἡδονή) and distress (λύπη).⁴¹ Indeed, the language Galen attaches to freedom from emotions, especially the verb ‘excise’ (ἐκκόψειε, Aff. Pecc. Dig. 3, 7.7 DB = V.8.1 K.), suggests Stoic eradication.⁴² Yet it should be noted that the theoretical account is rounded off by Galen’s critical modification that loving and hating too much can also be a form of affection, therefore arguing that Aristotelian moderation should also be taken into account as a principle in a regulated emotional life (Aff. Pecc. Dig. 3, 6.25-7.6 DB = V.7.10-8.1 K.). This shows that, although the semantics of eradication is at play here, Galen, as we have noted in other Chapters, does not favour avoiding all kinds of affectivity, but only its more severe and destructive manifestations. In the case of anger, for example, in Character Traits Galen accepts a rationalised type of that passion, such as that performed in battle by a courageous agent (De Mor. 31-32 Kr.).⁴³

In setting out, for the reader’s convenience, a number of criteria for identifying the impartial advocate then, Galen differentiates the latter from the generic type of the flatterer, a repulsive stock character in moral writings. This is the starting point for a sustained argumentation, which makes the flatterer’s way of life repellent to readers through ‘class fraction’. In Galen’s vivid description, the person who opts for money, power, esteem and reputation, conversing and dining on a regular basis with high-profile acquaintances in the city, will hardly be a lover of truth; he will be a dissimulating, self-interested liar. Conversely, the man who dismisses worldly needs and embraces a disciplined daily regime is more likely to speak the truth and be a genuine friend (Aff. Pecc. Dig. 3, 7.11-8.1 DB = V.8.6-9.7 K.). It is not entirely clear whether Galen believes that a philosophically minded person should be unaffected by the concerns or aspirations of this world, but, as we will see below, he does seem inclined to suggest, as in his Recognising the Best Physician or Prognosis, that pre-philosophical engagements present numerous moral challenges.

More importantly, the description of the addressee’s interaction with his moral director has something significant to say about the nature of Galen’s ethics. It shows that it is very hands-on and deeply rooted within a broader social context, while problematising human behaviour on a macrocosmic level:

If you find that he [i.e. a potential moral advisor] is that kind of person [i.e. one who speaks the truth], take some opportunity to talk to him in private. Ask him to make evident to you directly which of the above-mentioned affections he sees in you, emphasising the gratitude you will feel towards him: he will be your saviour, even more so than the man who saves you when you have a bodily sickness. And if he promises that whenever he sees you in the grip of one of these affections he will make it evident to you, but after an interval of several days – days when he has spent time with you, of course – he has still said nothing, take him to task, and again ask him (even more persistently than before) to make known to you directly any act of yours which he observes to have been committed under the influence of affection. If he replies that his silence was due to his having observed no such action in you in the intervening period, do not readily believe him. Do not imagine that you have suddenly become free of error. There are two possible explanations. Either the friend that you have asked has been lazy in his attention to you, or his silence is due to shyness to criticise – or indeed reluctance to incur your hatred, because he realises that it is an almost universal human habit to hate those who speak the truth. Otherwise, the reason may be a reluctance to help you – or some other cause which I do not regard as praiseworthy. If you trust me, for the moment, when I say that it is impossible that you committed no error at all, you will subsequently praise me, when you see that all human beings commit countless errors every day, and act under the influence of countless affections, but are not themselves aware of it. So you should not imagine that you are anything other than human, either.⁴⁴

Aff. Pecc. Dig. 3, 8.1-21 DB = V.9.7-10.13 K.

Several aspects are worth commenting on here. First of all, Galen’s sequence of tips on how the addressee should act under specific circumstances shows that the latter is not yet an independent personality, but rather needs systematic guidance on their way to moral growth. We see Galen offering him all the necessary advice in a step-by-step process. Secondly, the interaction with the advisor is not just meant to guide the addressee in this specific situation, but to enable him to get to grips with patterns of social conduct more generally. The passage quoted above represents part of a book on social manners. In particular, the advisor’s posited a) indifference, b) reluctance to criticise or c) attract the other party’s disapproval, or, even worse, d) potential resentment of a fellow-man’s ethical progress, are all marked out as universal features of human conduct. Galen is in essence encouraging his audience to look out for the truth among any mendacities and sensitises them to the dissimulation and hypocrisy that can arise in the context of social etiquette. He warns them not to be deterred by the social conventions that hinder the revelation of truth; it is only when his audience is comfortable with exhibiting sincerity in social relations that they will be at ease with it on a personal level too. Consequently, the episode with the supervisor is not just a narrative of prescriptive moralism or a manual for a one-off incident. It is a moralising act of broader application with regard to how to regulate your behaviour in the quest for truth and virtue, what to expect from others while you do so, how to judge the quality of what they offer you and how to stick to your own moral priorities in what could prove tricky social relations. In that sense, Galen seems in tune with common standards in popular philosophical works of the later Roman period. For example, Seneca, in his Letter 94 ‘On the value of advice’, explains that, since precepts are context-specific and appropriate to individual cases,⁴⁵ the aim of the philosophical area dealing with advice should rather be to equip a person with the necessary discernment to apply the rules appropriate to the situation at hand by himself. Put differently, the aim is to habituate oneself to the general tenor of life and a critical state of mind, and not just provide oneself with tailor-made instructions for certain occasions.⁴⁶

A third point that is central to this same passage is that, with a view to pragmatic moralising, Galen shows compassion for the weaknesses of human nature and impresses the reader with a firm realisation that he should accept his wrongdoings, since he is neither perfect nor superhuman. Assuming that he was superhuman, would result in boastfulness and erroneous judgment. Indeed, a bit further down in the same context Galen reproves any tendency on the reader’s part to assume that he is a perfect god, since he does not believe in any radical moral conversions, only in long-term practice (Aff. Pecc. Dig. 3, 9.11-14 DB = V.11.8-12 K.).⁴⁷ This is in accordance with what has been suggested above, namely that Galen’s point is not so much about finding the right advisor, but more about how to develop a proper mindset by which to conduct oneself in life.

Politics and ethics: Free speech (parrhēsia) in context

Galen’s emphasis on accepting moral criticism, as discussed above, moves onto a description of what seems to be a gloomy socio-political reality of his day. The author declares that both well-off men on the one hand and men of political standing on the other hand are in a disadvantageous ethical position compared with their fellow citizens, because any potential critics will steer clear of revealing their passions, due to the hope of monetary gain (διὰ κέρδος) when it comes to well-off men, and due to fear (διὰ φόβον) when it comes to politicians (Aff. Pecc. Dig. 3, 10.19-21 DB = V.13.6-10 K.). This observation leads Galen to go as far as to say that, if someone of great wealth desires to become a decent human being (γενέσθαι καλὸς κἀγαθός), he will have to put aside any worldly privileges, especially now that there is no Diogenes (of Sinope) with the courage to speak frankly to him (Aff. Pecc. Dig. 3, 10.22-11.3 DB = V.13.11-15 K.). How to interpret this? Are we to take these utterances at face value, as if they are suggesting that state offices and riches preclude any chance of moral excellence? This is not very likely, given that just a few lines later in the text Galen’s own father is presented as both politically active and virtuous. In the same vein, elsewhere Galen posits that statesmanship is in practice driven by love of humanity and justice (De Mor. 36 Kr., De Mor. 51 Kr.) and in another instance he tells a story that has his fellow citizens in Pergamum pushing a Platonist professor into politics on the grounds that he was ‘just, indifferent to money, approachable and mild’.⁴⁸ Nor is abstention from politics what Galen is proposing here, since he considers participation in political affairs and showing concern for people (τὸ πολιτεύεσθαι καὶ προνοεῖν ἀνθρώπων) the responsibility of noble and good men (ὑπὸ τῆς τῶν καλῶν καὶ ἀγαθῶν ἀνδρῶν σπουδῆς, Ind. 14, 82.16-18 PX). In this context, it would be more reasonable to argue that, on a first level, this statement is used to reassure Galen’s addressee, who is not said to be politically or financially powerful,⁴⁹ that he has better chances of moral success than other reference groups who are truly sunk in vice, devoid of any hope of salvation (Aff. Pecc. Dig. 3, 11.4-7 DB = V.13.16-14.1 K.). On another level, the statement may also function as a warning that worldly engagements can have challenging moral consequences. This squares with the earlier delineation of the flatterers who associate themselves with rich people, politicians and monarchs, and all the dark realities involved in those cases. To Galen’s mind, political life and wealth are potentially vicious moral climates, whereas philosophy is seen as a path towards introspection and an affect-moderated life. In another section of this Chapter, I will discuss how Galen, in a similar fashion, presents insatiability as the main cause of grief, thus once again arguing for a worldly explanation for destructive passions.

Galen’s emphasis on frank criticism of error is also interesting, because it relates to its use as a professed psychagogic approach in ancient philosophy. We know, for example, that the Epicurean Philodemus (1st c. BC) produced a work entitled On Frank Criticism (Περὶ παρρησίας, De Libertate Dicendi) to explore the concept of openness as the cornerstone of moral reform.⁵⁰ Michel Foucault, in developing the modern concept of parrhēsia as a mode of discourse, relies heavily on the ancient Greek understanding of the term, which meets certain prerequisites, all of which feature in Galen’s own account of parrhēsia:

[T]he parrhēsiastēs is someone who takes a risk … When, for example, you see a friend doing something wrong and you risk incurring his anger by telling him he is wrong, you are acting as a parrhēsiastēs. In such a case, you do not risk your life, but you may hurt him by your remarks, and your friendship may consequently suffer for it. If, in a political debate, an orator risks losing his popularity because his opinions are contrary to the majority’s opinion, or his opinions may usher in a political scandal, he uses parrhēsia. Parrhēsia, then, is linked to courage in the face of danger … And in its extreme form, telling the truth takes place in the ‘game’ of life or death.⁵¹

As per Foucault’s description, the moral advisor in Galen is a parrhēsiastēs, who has an unnegotiable commitment to truth and opts for sincerity rather than falsehood, flattery or self-interest. He is also a person ‘who has the moral qualities which are required, first, to know the truth, and secondly, to convey such truth to others’.⁵² This puts him in a position of risk, either with regard to his own social growth or his relationship with the recipient of his criticism. Still the moral advisor/parrhēsiastēs does not succumb to social pressure or fear, but prefers to remain faithful to truth, which he considers his moral duty, as a means of helping improve other people. Key examples mentioned by Foucault are Plato’s exchange with Dionysius of Syracuse, as described in Plutarch’s Life of Dion, or Socrates’s didactic role in the Platonic dialogues more generally,⁵³ although parrhēsia becomes part and parcel of the self-presentation of later moral philosophers, such as Seneca and Epictetus. Moreover, in line with Foucault’s understanding of the parrhesiastic enterprise, Galen’s own use of parrhēsia also points to a ‘speech or verbal activity’ ‘linked to a certain social situation’,⁵⁴ and, especially in Galen’s philosophical programme, it is associated with ‘the care of the self’ and ‘the education of the soul’.⁵⁵

The Foucauldian characteristics of the parrhēsiastēs also align with Galen’s description of his fellow student Teuthras, an example par excellence of a frank person, who in Bloodletting, Against the Erasistrateans at Rome becomes Galen’s guide in his encounter with a group of senior Erasistratean physicians. In this episode, Galen refers to Teuthras as exceedingly frank in his ways (ἦν δὲ πάνυ τὸν τρόπον ἐλεύθερος) and reveals the hallmarks of his activity: he addresses problematics with riveting honesty, urges reconsideration, affords ample evidence of phenomena not yet perceived by people in a disadvantageous position and resorts to bodily language to signify his contempt for those hiding the truth (Ven. Sect. Er. Rom. 1, 29.6-31.3 Kotrc = XI.193.6-195.3 K.). It is in the same light that we should imagine the activity of the moral advisor in Affections and Errors of the Soul, who is mentioned in the text as an exponent of openness mostly on a theoretical level, with his actual duties remaining unspecified.

Galen’s delineation of the moral advisor may be further illuminated by comparing it with Plutarch’s On Friends and Flatterers. This work presents key affinities with Galen’s Affections and Errors of the Soul in the way the advisor is seen as a true friend, although this connection is never explicitly made in Galen, because his advisor, unlike Plutarch’s friend, was not supposed to be acquainted with the recipient of his moral advice.⁵⁶ The concept of parrhēsia is pre-eminent in Plutarch’s essay,⁵⁷ sometimes in its deceptive version, which the flatterer adopts to mislead the agent (De Adul. et Amic. 51B-C; De Adul. et Amic. 59B-60C), and at other times in its sincere variety, the one used by the true friend. The latter is often combined with reprehension and stinging words, which render it therapeutic (θεραπευτικὴ παρρησία, De Adul. et Amic. 73A-E); it also shows genuine care for one’s fellow man (κηδεμονική, De Adul. et Amic. 55B-C) and should thus be mixed with seriousness and candour (σπουδὴν ἐχέτω καὶ ἦθος, De Adul. et Amic. 68C).⁵⁸ We see, therefore, that Galen’s basic distinctions in his account of parrhēsia conform to Plutarch’s own, although it is also remarkable that whereas Plutarch’s text is full of metaphors and analogies from medicine that illustrate the therapeutic action of openness (e.g. De Adul. et Amic. 55A-B, 63C-D),⁵⁹ there is almost nothing of this sort in Galen.⁶⁰ True, we do get some terminology that might have medical connotations (e.g. the excision of moral passions mentioned above), or very brief references to analogies from medicine (e.g. the ethical monitor is seen as a more important ‘saviour’ than the one who saves someone from bodily sickness, Aff. Pecc. Dig. 3, 8.3-4 DB = V.9.9-11 K.), yet we hardly find anything more extensive or specific to the medical art, as in other moralists.⁶¹ This aligns with Galen’s general practice of concealing his medical identity in the ethical contexts, most likely as a way of making his contribution to this quite different area of intellectual activity more visible and robust.⁶² This is not to say, however, that there is nothing pertaining to the body, because Galen exploits the medically-inspired trope of the body as an analogy for the soul, as we will now see.

Body and soul: Moral aesthetics and the therapy of anger

In underscoring the importance of life-long training (askēsis) as a prerequisite for moral progress, Galen contends that the care of the soul, irrespective of its condition, should never be neglected, just as the body is never abandoned when in a bad state. The author’s implication is that both soul and body are essential to our preservation as human beings, which leads him to advise that we should not allow our soul to become ‘utterly disgusting’ (πάναισχρον), comparing it to Thersites’s body (Aff. Pecc. Dig. 4, 11.15-25 DB = V.14.11-15.7 K.). The reference to Thersites here is quite effective, since he is the typical case of physical ugliness in Homer (αἴσχιστος, Iliad 2.216-19). Interestingly, in the Iliadic intertext Thersites comes off as ‘most hateful’ (ἔχθιστος, Iliad 2.220) not so much for his abhorrent appearance as for his objectionable moral qualities: his immoderate speech, disorderly words, utter reviling of the kings and his overall abusive behaviour (Iliad, 2.212-216, 2.220-223, 2.274-277), which eventually excited the Greeks’ indignation, leading Odysseus to strike him (Iliad, 2.265-271). This Homeric episode which underlies Galen’s account is far from frivolous, given that Thersites’s free speech is not based on healthy criticism but on ill-favoured obscenity, and is therefore not a proper manifestation of parrhēsia as advocated by Galen. The social response to Thersites’s sordid behaviour is also important, since he is bitten, mocked and humiliated in front of others, thus ushering in the social evaluation of moral ugliness, which strategically discourages Galen’s audience from disregarding their own psychic condition. According to this view, Thersites’s vulgarity, unlike the parrhēsia Galen espouses, could be linked to the modern notion of ‘Thersitism’, initially coined by Georg Wilhelm Friedrich Hegel and then taken up by Friedrich Nietzsche and above all the American literary theorist Kenneth Burke, among others. This is a literary device according to which the author of a work generates objection, contradiction or protest in his work but does so not in any explicit fashion, but through subsidiary characters who could be easily dismissed by the majority of readers.⁶³ In Galen’s case, his moralising narrative up to this point would have easily persuaded his readership neither to identify with the morally abominable Thersites nor adopt any of his social attitudes. This is what we have seen happening in Against Julian, where Galen also employs the antitype of Thersites for his general promotion of moral edification (Chapter 3).

The connection between body and soul takes on a more sophisticated form through the explicit association between bodily and psychic excellence:

For it is desirable, if one cannot have the body of Hercules, to have that of Achilles; or, failing that, the body of Ajax, Diomedes, or Agamemnon or Patroclus; or, failing those, the body of some other admirable heroes. So too with the soul: someone who is unable to have the perfect sort of good condition would, I believe, settle for being second, third or fourth from top. And this is not impossible for one who has decided to exert himself for a long period in a process of constant training.⁶⁴

Aff. Pecc. Dig. 4, 12.3-10 DB = V.15.11-16.3 K.

What the passage cited above conjures up is a feeling of assessment, competition and social classification, which develops into the aesthetic assessment of emotions. Specifically, Galen recalls a series of incidents he has experienced personally, all of which negotiate the pathology of anger, i.e. its causes and effects, as well as its ‘staging’, (i.e. how the passion is rhetorically shaped and performed),⁶⁵ using them as literary techniques to warn readers against falling victim to such damaging psychological conditions.

The first episode adumbrates how a person rushing to open a door did not succeed in the task, and so, in the grip of extreme anger, he began ‘biting the key (δάκνοντα τὴν κλεῖν), kicking the door (λακτίζοντα τὴν θύραν), cursing the gods (λοιδορούμενον τοῖς θεοῖς), rolling his eyes wildly as madmen do (ἠγριωμένον τε τοὺς ὀφθαλμοὺς ὥσπερ οἱ μαινόμενοι), and all but frothing at the mouth like a boar (καὶ μικροῦ δεῖν αὐτὸν ἀφρὸν ὡς οἱ κάπροι προϊέμενον ἐκ τοῦ στόματος)’ (Aff. Pecc. Dig. 4, 12.11-15 DB = V.16.3-9 K.).⁶⁶ The link Galen makes between behavioural ferocity and impropriety, on the one hand, and elements of mental disturbance⁶⁷ together with bodily disfigurement on the other, underpins and helps to justify his evaluative response to the spectacle: ‘I hated this rage so much that I would never be seen thus disfigured by it’ (ἐμίσησα τὸν θυμὸν οὕτως, ὥστε μηκέτ᾽ ὀφθῆναι δι᾽ αὐτὸν ἀσχημονοῦντά με, Aff. Pecc. Dig. 4, 12.11-15 DB = V.16.3-9 K.). An extreme emotion (hatred) arises from the observation of another (truly revulsive) extreme emotion (anger); while the language of behaving in an unseemly fashion and disgracing oneself, represented by the participle ἀσχημονοῦντα, flags up the social perception of anger in terms of its aesthetic evaluation, as with the Thersites example above. The interrelation between moral and aesthetic ugliness was pervasive in ancient moral works, as noted (Chapter 2),⁶⁸ but in Galen’s text this is taken further in the author’s direct prescription to readers that the ugly displays of this passion should be restrained by all possible means and concealed from public view (ἀλλ’ ἐν σαυτῷ κατέχειν τε καὶ κρύπτειν τὴν ὀργήν … κατασχεῖν δὲ τὸ τοῦ πάθους ἄσχημον δύναται, Aff. Pecc. Dig. 4, 12.19-21 DB = V.16.13-16 K.).

William Harris sees this episode as mere fiction, citing striking parallels from Chrysippus and Philodemus (SVF III.478; cf. Philodemus, On Anger fragm. 8 Indelli) to substantiate his claim that biting the key when the door fails to open is pretty much a trope with an instructive aim.⁶⁹ To endorse Harris’s view that the episode could be constructive, one could also add that the ‘rolling eyes’ Galen assigns to the enraged man fits the symptomatology of the raging patient and also the examination of a patient’s eyes as a diagnostic tool for the presence of severe rage.⁷⁰ In Galen’s case, the ‘staged’ display of this passion, as argued in this Chapter, augments the image’s impact on the audience and therefore renders the mastery of the passion even more pressing, in the mode of an ‘aversion therapy’.⁷¹ Spectacularised fiction is put at the service of moral didacticism.

To return to the Galenic episode, direct counselling is superseded by four further types of moralising discourse:

1. a) influencing the reader by means of personal example, and more specifically through a brief story about how, as a boy, Galen was trained by his father not to strike any household servants, thus stressing how early discipline can produce proper habits for adult life (Aff. Pecc. Dig. 4, 13.1-4 DB = V.17.3-6 K.).

2. b) Embedded within the above narrative is the exemplum of Galen’s father as a moral monitor for other people, whom he reprimanded for having bitten their servants when in a state of uncontrollable anger (Aff. Pecc. Dig. 4, 13.4-8 DB = V.17.6-12 K.).

3. c) An anecdote involving the emperor Hadrian stages his irascibility, which led to the physical maltreatment of an enslaved person, causing him to lose an eye (Aff. Pecc. Dig. 4, 13.12-18 DB = V.17.16-18.4 K.).⁷² This anecdote is attached to an episode involving one of Galen’s friends from Crete who was also irascible, thus suggesting that anger is a universal trait of human behaviour, irrespective of ethnic identity and socio-political standing.

4. d) This incident with Galen’s friend from Gortyn in Crete is framed as an ethical case history.⁷³ The protagonist is a patient with a moral affection, in this case excessive anger, and a close acquaintance of Galen. The narrative is initially focused on an overall description of the patient’s ethical condition: despite being straightforward, admirable, friendly, kind and liberal, he was also exceedingly hot-tempered so that he often inflicted corporal punishment on his servants. After that, the aetiology of the passion is described, illustrated by a trip this friend made outside Rome with Galen when, in the grip of extreme rage, he brutally attacked his two servants using a knife.⁷⁴ The realisation of what he has done led him to repent and ask Galen to flog him as punishment for his ‘accursed rage’, as he called it. Galen responds to his friend’s remorse with amused contempt (he laughs in disapproval) in emulation of Socratic jesting (παιδιά)⁷⁵ and accordingly invites his audience to distance themselves from a similar display of this emotion.⁷⁶ The objectification of the Cretan friend in the narrative therefore may be seen as:

   ‘a kind of moral voyeurism in which only the “I” and the “you” of the discourse have real choices; the many other characters introduced as examples of the passions simply provide a kind of ethical peep show, eternally cranking through their despicable – or pitiable – behavior patterns at the behest of the philosopher and his pupil’.⁷⁷

After the patient’s description of emotional symptoms comes Galen’s therapeutic enterprise. This encompasses a lengthy discussion between Galen and the patient, clarifying to the latter how the thymoeidic (spirited) part of the soul is schooled not through flogging, but through the power of reason (logos), involving verbal communication (in the form of Socratic dialectics) to remedy someone’s behaviour and establish well-founded, long-term moral habits (Aff. Pecc. Dig. 4, 13.19-15.5 DB = V.18.4-20.9 K.). This is also known as the ‘therapy of the word’.⁷⁸ It should be noted that Galen’s actual therapeutic lesson is never amplified in the text, only implied, and that the only thing that matters for the purposes of the narrative is to stress the positive outcome of Galen’s therapy.

Indeed, this moral clinical encounter is rounded off with a dedicated section on prognosticating how the moral affection improved in the space of a year, with Galen extrapolating the prognostic time-plan of moral progress and attaching it to the addressee of the essay this time, so as to inform him what kind of progress he could expect to have in years to come (Aff. Pecc. Dig. 4, 15.6-15 DB = V.20.9-21.5 K.). This and the other case histories that I describe as ethical share the majority of the formal and structural criteria of Galen’s medical case histories as analysed by Susan Mattern, which are: a) the three-stage medical process of diagnosis, cure, prognosis and the corresponding three-stage narrative process of background (a patient’s history before Galen’s intervention), crisis (encounter with Galen) and resolution (recovery); b) the demarcation of medical time; c) the use of a recollected narrative form in the aorist tense and indicative voice; d) their identification as stories that derive from Galen’s experience and which he himself acknowledges as distinct units of discourse; e) their use not just to substantiate a medical point but also to transmit medical knowledge through examples (παραδείγματα), while f) simultaneously promoting the author and establishing his relationship with his audience.⁷⁹ These affinities show that, in producing his own version of a widely-used and adaptable form of moral preaching and specifically employing ethically troubling cases or stories, what I have called ethical case-histories, Galen is inspired by his medical knowledge and experience of clinical encounters with patients (see also Chapter 4).

Despite the low social status of household slaves in classical antiquity (e.g. Plato in the Laws, Book 6, 777e-778a, favours punishing them when they err, while Aristotle in Politics 1253b.32 regards a slave as merely a live article of property), in the post-Hellenistic ethical-philosophical legacy, the relation between master and servant became a Leitmotif when proposing the control of anger. Epictetus, for example, in discussing the treatment of slaves, asserts that masters could stop themselves exploding with rage when slaves were disobedient or mistaken, by bearing in mind the natural brotherhood that connects the master and the slave (Discourses 1.13). Seneca proceeded along similar lines in his On the Control of Anger (e.g. 1.15, 2.25, 3.12; cf. Letter 47 ‘On master and slave’), while comparable moral attitudes are espoused by Plutarch in his own On the Control of Anger.⁸⁰ Strikingly enough, this Plutarchan text shows important thematic resemblances with Galen’s mini script on the pathology of anger cited above: a) specifically the proem to Plutarch’s text presents the dialogue between two close friends, Sulla and Fundanus, who have been reunited in Rome for five months now, after Sulla’s annual absence from the city. This daily association, which is also important in Galen’s rapport with his Cretan friend, makes Sulla realise the moral progress Fundanus has made in controlling his anger. b) The text suggests that this was made possible by the use of therapeutic words – what Galen calls ‘the power of logos’ in his own text – and the fact that Fundanus’s thymoeidic part has been willingly subjected to the power of reason (De Coh. Ira 453B-F). c) Plutarch, like Galen, also emphasises the display of this emotion (De Coh. Ira 455B), the social reaction to it, which generates laughter, hatred and scorn in spectators (De Coh. Ira 455E), the observation of the passion in other people who suffer from it, especially their facial and bodily deformity, as a way of distancing oneself from it (De Coh. Ira 455E-456E, De Coh. Ira 458D), and its aesthetic assessment (De Coh. Ira 456C-D). d) More importantly, the Plutarchan intertext also includes an extensive account of the arousal of anger particularly in interactions with slaves (De Coh. Ira 459C-460C; cf. De Coh. Ira 460F-462B). The above evidence makes it probable that Galen positioned himself, alongside other luminaries, in a long-standing tradition of practical ethics that offered practical tips for the regulation of anger.⁸¹

Although ancient moralists as a rule acknowledged that anger was an affection of the soul, Plutarch and Seneca put significant emphasis on its display as mental illness and described its physicality as madness, highlighting its medical associations, especially its aetiology and mostly its physiological symptoms. Seneca On the Control of Anger 1.1 is informative:

Some of the wisest of men have in consequence of this called anger a short madness: for it is equally devoid of self-control, regardless of decorum, forgetful of kinship, obstinately engrossed in whatever it begins to do, deaf to reason and advice, excited by trifling causes, awkward at perceiving what is true and just, and very like a falling rock which breaks itself to pieces upon the very thing which it crushes. That you may know that they whom anger possesses are not sane, look at their appearance; for as there are distinct symptoms which mark madmen, such as a bold and menacing air, a gloomy brow, a stern face, a hurried walk, restless hands, changed colour, quick and strongly-drawn breathing, so too the signs of angry men are the same: their eyes blaze and sparkle, their whole face is a deep red with the blood which boils up from the bottom of their heart, their lips quiver, their teeth are set, their hair bristles and stands on end, their breath is laboured and hissing, their joints crack as they twist them about, they groan, bellow, and burst into scarcely intelligible talk, they often clap their hands together and stamp on the ground with their feet, and their whole body is highly-strung and plays those tricks which mark a distraught mind, so as to furnish an ugly and shocking picture of self-perversion and excitement.

This is the kind of (quasi-)scientific material one would expect to find in Galen, yet it is simply never there, at least not in any refined or detailed exposition.⁸² What Galen does instead is to add classical commonplaces from popular philosophy relating to anger, while minimising any medically-oriented associations or connotations that explain the passion. For example, he employs the philosophical motif according to which one should postpone punishment of servants while one is still angry (Aff. Pecc. Dig. 5, 15.21-16.4 DB = V.21.12-22.3 K.) – familiar from other moralists,⁸³ and then he inserts a passing reference to the way he theorises anger as a kind of mental disturbance (μανία and its cognates are used four times) with its accompanying outward expressions (kicking, biting, tearing of clothes, Aff. Pecc. Dig. 5, 16.5-15 DB = V.22.4-18 K.). The closest Galen gets to a more scientific understanding of the affection is through his reference to it as a ‘boiling’ of the thymoeidic component of the soul (Aff. Pecc. Dig. 5, 16.4 DB = V.22.4 K.). We know that anger as the boiling of the blood in the heart has a strong scientific grounding in more technical Galenic works,⁸⁴ yet in the Affections and Errors of the Soul Galen does not give any further details on any of these physical correlates of affections of the soul. He remains sharply focused on philosophical themes that would have been pretty much conventional in the genre of the therapy of emotions. Galen persists in not sacrificing his claims to being taken seriously in the area of ethics. His ethical works will not be judged by medics anyway, so he sees no point in saturating them with medical terminology. To that end, he also broaches the theme of human rationality versus animality and uses it as a moralising mechanism to deter his readers from demonstrating uncontrollable rage in real-life situations, especially in their relations with less powerful people.⁸⁵ Similarly in Chapter 5, which focused on the Exhortation to the Study of Medicine, we have seen that Galen taps into the topic of bestiality, in order to commend the monitoring of damaging passions through the medium of rational judgment. This he sees as morally edifying for the Graeco-Roman elite to whom his works are addressed. In the Affections and Errors of the Soul, however, he links irrationality with bestiality specifically in order to arouse his audience’s sense of shame.

The shame of others and self-shame

In assigning to humans alone the gift of rationality, Galen hammers home the idea that, by achieving gratification through anger, his readers were lowering themselves to the level of animals. The animal imagery is structured around the divide between a reflective human being (φρόνιμον ἄνθρωπον), who attempts to become noble and decent (ἄνθρωπος γενέσθαι καλὸς κἀγαθός), and a wild beast, an image that crops up very frequently in this context. Beyond the actual philosophical overtones here (the desiderative is traditionally seen as an untameable animal), assimilation to a wild beast rhetorically denotes foolishness, and so Galen goes on to label the agent a ‘slave of anger’, which he defines as not being sufficiently free of the affection as to act on the basis of mature consideration (Aff. Pecc. Dig. 5, 16.19-17.1 DB = V.23.3-13 K.). The associations with animality create derogatory innuendos in readers’ minds as a way of discouraging them from embracing what Galen regards as manners unsuitable to humans.

Galen also plays on his addressees’ sense of social esteem by arguing in a rhetorical fashion that they will demonstrate their superiority over everyone else (ἑαυτὸν ἐπιδεῖξαι πάντων ἀνθρώπων βελτίονα) and achieve the greatest honour (τιμήσαντός σου τιμῆς σεαυτὸν μεγίστης), if they manage to stay free from anger (Aff. Pecc. Dig. 5, 17.2-4 DB = V.23.14-17 K.). Here the author seems on a first level to be espousing the Stoic model of apatheia, complete abstention from passions. However, in the context of his exposition what he really wants to emphasise is not the strict application of a theoretical doctrine on the eradication of emotions, but rather the ability of the moral agent to contain unrelenting affections, as we have seen in Chapter 4. In my reading, Galen does not go on to talk about the moderation of passions in this section of the Affections and Errors of the Soul (though he does that slightly later in the work),⁸⁶ because he tailors the content and style of his narrative to the credentials of his readers, who are depicted as having a rather crude sense of moral consciousness and falling short of the philosophical mindset required to have a full grasp of the workings of passions. So for Galen it is more vital to address such readers in a very direct way (‘Abstain from the passion!’), without taking into account the niceties of complex philosophical differentiation in the use of affect-related terms.

That Galen’s advice is very pragmatic rather than speculative is seen in the fact that he then proceeds to distinguish between appearing to be morally superior and actually being so, which flags up the issue of false reputation as opposed to reality in social interactions in Galen’s time (Aff. Pecc. Dig. 5, 17.5-6 DB = V.23.17-24.3 K.; see also Chapter 8). For Galen it is absolutely fundamental that the person should remain faithful to his decision to practise self-honour, a course which is genuine and self-determined, and avoid giving false impressions to others and above all to oneself (Aff. Pecc. Dig. 5, 18.3-4 DB = V.25.7-8 K.). In fact, the issue of social affectation and moral genuineness seems to form the core of Galen’s ensuing recommendation that the addressee should leave the door of his house constantly open and allow free entrance to all acquaintances, which underscores the notion of moral exposure and therefore alertness (Aff. Pecc. Dig. 5, 18.14-25 DB = V.26.2-16 K.). The rationale behind this admonition is that, just as agents protect their image in the public space, they should also be mindful of their inner condition in the private sphere as well. In other words, social shame should have a counterpart in a person’s relation to the self too. Exposing onself to public scrutiny as a sign of moral propriety especially in private affairs features in other popular philosophical works, such as Plutarch’s Political Precepts 800F-801A, but in the passage from Galen referred to above it is directly used as a moralising device to help the reader keep the non-rational principle of the soul in constant check.

Situational ethics: Dietetics as a moralising space

Somewhere half-way through the essay, Galen cross-references his work on Character Traits to substantiate his discussion of the proper monitoring of the desiderative faculty of the soul (epithymētikon), that is the one connected with bodily pleasures, impulses and desires (Aff. Pecc. Dig. 6, 19.8ff DB = V.27.6 ff K.).⁸⁷ The considerable length of this section and its technical character, which is at odds with the popular philosophical nature of what comes before and indeed after it, leads us to assume that this is a non-functional detour and presumably represents a later addition to the text by Galen during the revision stage of the oral version.⁸⁸ This suggestion is backed up by a) the awkward recapitulation of the role of the candid critic and other psychotherapeutic tactics already sufficiently covered in the work (Aff. Pecc. Dig. 6, 20.32-21.10 DB = V.30.3-18 K.), b) the almost complete absence of popular philosophical components, such as edifying stories (exempla) and proverbs, which are now replaced by a relatively processed theoretical account, and c) the fact that the Galenic moralism is now strictly hortatory, communicated in the second-person singular, and focuses on the author’s (conceited) notion of himself as a moral philosopher for all men (e.g. Aff. Pecc. Dig. 6, 20.16-17 DB = V.29.11-13 K.), having dropped the dynamics it previously employed that were based on a range of strategies aiming at bringing about ethical reform.

That said, the discussion of the desiderative soon gets linked to a number of guidelines on how one should eat and drink especially in the context of a dinner party. Galen now amply spells out what he expounds less explicitly in the naturalistic accounts of The Capacities of the Soul Follow the Mixtures of the Body and Matters of Health regarding dietetics as a site of moral education (Chapter 2), with a notable degree of conceptual coherence between what he says in the Affections and Errors of the Soul and these two works. As I will go on to show, his thematic turn towards dietetics in Affections and Errors of the Soul points to Galen’s interest in situational ethics, i.e. social or cultural occasions that provide opportunities for behavioural training, habituation to a specific form of conduct, and therefore moral progress. From Aff. Pecc. Dig. 6, 21.11 DB = V.31.18 K. onwards the discussion centres on how to cure oneself of gluttony and drunkenness, among other things, just as one should become accustomed to practising freedom from anger. So, with the focus firmly on passions that affect the desiderative soul, Galen proceeds to show that daily events such as meals and eating in the company of others, which were deeply entrenched in the realities and social habits of his Graeco-Roman wealthy addressees, can be morally challenging:

And therefore another person must watch over us, to ensure that we do not make the same spectacle of insatiable gobbling of food as dogs, or gulp down a cold drink like someone in the throes of continuous fever, in a way unbefitting a man of dignity. Even when one is hungry, it is not appropriate to gobble in a violent and insatiable manner; nor, if one is thirsty, should one drink down a whole goblet in one go. How much less should a luxurious appetite lead one to indulge more than all one’s fellow diners in cake or any other rich food. In all these situations, when beginning the process we should call upon others to observe any errors we make, and tell them to us; later on, let us conduct the observation upon ourselves, even without tutors, and let us take care that we take less food than all our fellow diners, and that we abstain from the rich foods, and take a moderate amount of the healthy ones.⁸⁹

Aff. Pecc. Dig. 6, 21.12-22.2 DB = V.31.2-16 K.

Regulation by others and afterwards self-discipline at the table is what is advocated, with a number of moral ploys that Galen uses elsewhere being in evidence here as well: e.g. the animal analogy of the covetous dog, which is designed to discourage readers from insatiability as a reprehensible form of eating behaviour, or the notion of public appearance that conditions the way the moral agent is perceived and evaluated by his fellow-citizens in the context of the dinner party. Later on, Galen helps readers internalise appropriate ethical attitudes by warning them not to succumb to unnecessary competition with or envy of their fellow diners in respect of the self-restrained consumption of food and drink: ‘And after a while I would say that you should not even consider the amount consumed by your fellow diners; for it is no great achievement to be more restrained than they with regard to food and drink (μέγα γὰρ οὐδὲν ἐκείνων ἐσθίειν τε καὶ πίνειν ἐγκρατέστερον)’ (Aff. Pecc. Dig. 6, 22.3-5 DB = V.31.16-32.1 K.). The idea is to stay focused on one’s eating behaviour, minimising any self-centred pride that might arise from practising moderation. Indeed, self-understanding and self-examination form the basis of Galen’s moralising programme here:

If you have learnt truly to esteem yourself, consider whether you are more restrained in your daily regime yesterday or today. Following this practice you will become conscious each day that it is easier to abstain from the foods that I have mentioned; and conscious of a greater joy of the soul, if you really are a lover of self-control.

Aff. Pecc. Dig. 6, 22.5-9 DB = V.32.1-6 K.⁹⁰

The introduction of the suggested reflective exercises by Galen is associated with his self-positioning as a moral authority, which provides assurance that the beliefs he commends to his addressee, and by implication to society at large, are morally edifying.

Another remarkable feature of Galen’s moral advice in this section is that he attaches positive connotations to what might be seen as morally ambiguous terms. Specifically, he compares the extremes (ἀκρότητα) of drinking too much, overeating and having too much sex, to the peak of self-control (σωφροσύνης ἀκρότητα, Aff. Pecc. Dig. 6, 22.15-17 DB = V.32.13-15 K.).⁹¹ It is interesting that, even though the primary meaning of ἀκρότης (akrotēs) as ‘extreme’ might seem to be opposed to the Aristotelian μεσότης (mesotēs, moderation), its metaphorical meaning can be linked to excellence, perfection or the summit of a thing or an activity,⁹² so it is positively loaded in a text on ethics. For example, in Nicomachean Ethics 1107a6–8, we read ‘That is why virtue, as far as its essence and the account stating what it is are concerned, is a mean, but, as far as the best condition and the good result are concerned, it is an extreme’.⁹³ Similarly, Galen is in favour of a positive, productive kind of competitiveness, the sort that takes place when trainees in philosophy surpass those who are engaged in the same endeavours as them or one that has to do with surpassing oneself (Aff. Pecc. Dig. 6, 22.17-20 DB = V.32.15-33.2 K.). The term used is φιλονεικία (philoneikia), which in Galen, as in other Imperial-period authors, predominantly denotes ‘love of strife’, ‘contentiousness’, but in this case he opts for the less common meaning, that of ‘emulation’ and so he is using it in a positive sense.⁹⁴ Galen therefore plays with the lexical flexibility of morally-loaded terms. He is happy to harness negative phraseology and transform it into something positive in order to problematise certain moral situations and justify moral disapprobation.

One final point must be discussed in this context. Galen makes a strong case that long-established habit (ēthos) will make healthy eating easy and pleasant, and therefore renders the latter an indispensable part of one’s daily regimen. The author is also adamant in his view that the example of a controlled diet can provide a basis for an analogous approach to remedying psychic insatiability. Dietetics was an essential part of ancient medicine, which compared with the other two branches of therapeutics, namely pharmacology and surgery, was the most conspicuous and socially acceptable (e.g. Scribonius Largus, epistula dedicatoria 2; Plutarch, On Friends and Flatterers 73D). Galen gives us good reasons why this might have been the case by showing that dietetics was indeed an area liable to promote individual and social righteousness. Such opinions crop up time and again in Galen’s Matters of Health, his dedicated work on the importance of dietetics, a term that includes not just foodstuffs, but, as seen in Chapter 2, a wider range of environmental aspects affecting the body such as exercise, sleep, baths, massage, sexual activity and so on, which the agent ought to enjoy in moderation.⁹⁵ So Galen develops the idea that the human being will be happiest, if he is brought up from birth in a regime that prizes the art of hygiene; ‘for he will thus gain some benefit for his soul too (εἰς τὴν ψυχὴν ὀνίναιτο), since a good daily regime paves the way for good character traits (τῆς χρηστῆς διαίτης ἤθη χρηστὰ παρασκευαζούσης)’ (San. Tu. 7, 16.2-5 Ko. = VI.31.18-32.5 K.). Elsewhere, it is underlined that the character of the soul is corrupted by bad habits in respect of food, drink or physical exercise, and therefore it is not only the business of the philosopher to shape the character of the soul (πλάττειν ἦθος ψυχῆς) but somehow that of the doctor too, who is often called upon to prevent or correct the deleterious effects that moral affections have on the body (San. Tu. 8, 19.24-20.3 Ko. = VI.40.4-17 K.). Galen’s identity as a doctor is not involved in the Affections and Errors of the Soul (cf. the last section of this Chapter), but his contention that bodily and psychic health are interdependent certainly is, as we have seen. This is in tune with Plutarch’s Precepts of Health Care, a work that combines the demands of health care and the expectations of moral decorum at dinner parties and other outings (e.g. 123D-E) in highly sophisticated ways, as has recently been shown.⁹⁶

Galen’s wider image of the physician who infiltrates into the territory of ethics also features in The Capacities of the Soul Follow the Mixtures of the Body, as already argued in Chapter 2. Here the same core idea is put forward: since a deficient bodily condition (krasis) causes a bad state of the soul, by restoring bodily mixtures, the doctor can achieve psychic stability. Earlier literature has explained this thesis as reflecting Galen’s physicalist approach to the therapy of the passions (see Chapter 2). But beyond that, the ethical layer with which Galen invests these texts hints at his claims to be seen as a moralist, independently of or in conjunction with his authoritative expertise in medicine for which he was best known. An interesting passage in Plutarch’s Precepts of Health Care 122B-E dramatises a contemporary discussion as to whether the two groups (physicians and philosophers) should have distinct areas of specialisation and knowledge or whether some ‘blurring of boundaries’ (σύγχυσιν ὅρων, 122C) could be permissible. Galen seems to be responding to the ongoing debate over the demarcation of the duties of doctors and philosophers, and suggesting that his medical role should not (and does not) preclude his competence in the field of ethics. In this way he also bolsters his general self-image of the physician-cum-philosopher, specifically disposed to ethics as much as to logic and physics. We will see that this holds true for Prognosis (Chapter 8) too, where once again Galen casts himself as a moral authority, notwithstanding his more developed medical image in this text.

This proposal is consistent with Galen’s ideas about specialisation, which he endorsed in an inclusive way, i.e. not excluding contributions from specialists in other disciplines. He often argues that specific topics need, ideally, to be discussed by professionals from the corresponding field. However, he does welcome the input of other professional groups on given topics, provided that their approach is rational and methodologically sound, thus acknowledging the advantages of an interdisciplinary approach to specialisation. So, for example, in Matters of Health he states that hygiene should ideally be discussed by physicians and gymnastic trainers, though it was often dealt with by philosophers too. In the Construction of the Embryo he says that this topic should be tackled by physicians, though philosophers have attempted to give an opinion on it too. In Doctrines of Hippocrates and Plato he mentions that the powers that govern animals should be examined by both philosophers and physicians. And the same emphases obtain in the introduction to the Diagnosis by the Pulse (Dig. Puls. 1.1, VIII.766.3-767.7 K.). This shows that Galen does not favour rigid segregation of areas of expertise, which at any rate did not form part of the public perception of the doctor’s identity in antiquity either. As Nutton remarks: ‘The boundary between the self-acknowledged doctor and the educated layman was very narrow. The distance that separated a Galen from a Cornelius Celsus or a Seneca is far less than that between a modern cardiologist and the average G.P.’⁹⁷

Moral emulation

In another section of the Affections and Errors of the Soul, Galen turns to a detailed analysis of the passion of distress or grief (lypē), having re-confirmed his status as an expert in matters ethical. Specifically, by means of self-effacement – a favourite technique in the proem to the text and an enduring authorising gesture in the knowledge-ordering culture of the Imperial period –⁹⁸ he claims in feigned ignorance that if there is any other way by which one could become a noble man, he would be happy to accept it, but otherwise his addressee(s) should stick to his own method of diagnosis and treatment of passions, until a better one is discovered (Aff. Pecc. Dig. 7, 24.4-10 DB = V.35.3-10 K.). This passage resembles an earlier one, i.e. Aff. Pecc. Dig. 2, 6.16-24 DB = V.6.17-7.9 K. (see part 3 of this Chapter), which it revisits. As I have argued above, the gist of this passage was to urge readers to actively explore other possible therapeutic methods. However, here Galen’s method is specifically called ‘common to all’, suggesting that its application is universally acceptable and efficient, thus potentially restricting any unnecessary searching on the reader’s part. Moreover, Galen’s affectation is also evinced in his ostentatious pretence of humility, when he says that he expects people whom he has benefitted morally to ‘return the favour, with some reciprocal benefit and teaching’ (παρακαλῶν ἀντιδιδόναι τε καὶ ἀντονινάναι τι καὶ ἀντιδιδάσκειν, Aff. Pecc. Dig. 7, 24.7-8 DB = V.35.6-7 K.), a statement that is at odds with the way Galen goes on in the text to present himself as a didactic paradigm of firm resistance to distress. It seems he barely needs any help from others. This image of him occurs in the context of a story about a young man who used to easily get upset over minor issues and therefore visited Galen for advice.

A number of components in this story cast light on the primary features of Galenic moralism:

1. a. The young age of the person who approaches Galen is linked to the intensity of the passion. This squares with Galen’s – and other moralists’ – view that there are affections that are especially predictable in young men.⁹⁹

2. b. The story is acted out as a narrative with dramatic time and space within which the characters operate, as well as a determinant event, a turning point in the plot, as it were. In this case, the young man has a sudden realisation of his condition (κατανοήσας τοῦτο, Aff. Pecc. Dig. 7, 25.16 DB = V.37.6 K.), which leads him to stay awake all night and visit Galen first thing in the morning to find out the reason for Galen’s own immunity to distress.

3. c. From what we learn from this brief story, the young man is an acquaintance of Galen’s, who must have known him very well, as he remembered (εἰς ἀνάμνησιν ἀφικέσθαι, Aff. Pecc. Dig. 7, 25.18 DB = V.37.8 K.) the general pattern of Galen’s response to grief. This ties in with the close rapport Galen sets up between himself as moral advisor and his actual and intended readership in general, and the role of moral anamnesis in ethical progress (Chapter 4).

This ethical case history is not as fully fleshed-out as the one with Galen’s Cretan friend, but it does include two of the basic features of a unified ‘conversion narrative’,¹⁰⁰ i.e. background (description of the passion) and crisis (self-realisation of the condition). The resolution, or the outcome of the young man’s encounter with Galen, is not explicitly addressed, though the amplification of Galen’s therapeutic advice may be assumed to have steered the young man towards restraining his grief.

The elements of the story outlined above stress Galen’s impact as a moral teacher and lead him to make a firm declaration that natural inclinations are important in childhood as is emulation of fine exemplars, whereas at a later stage the important factors are doctrines and training (Aff. Pecc. Dig. 7, 25.21-24 DB = V.37.12-14 K.). I have discussed in Chapter 4 above the educational triad Galen envisages here as well as any discrepancies observed between this text and Avoiding Distress. For present purposes, I would like to touch briefly on the role of moral emulation here, which has important ramifications for Galen’s moralising role and the function of emulation as a staple of his moral agenda.

The relevant passage focuses on the portrayal of Galen’s parents’ characters, pointedly contrasting the two as role models for Galen during his formative period:

I did have the great good fortune to have a father who was to an extraordinary degree free from anger, just, good and generous; but I had a mother whose irascibility was so extreme that she would sometimes bite her maids. She was perpetually shouting and fighting with my father, even more so than Xanthippe with Socrates. Thus, as I saw alongside each other the fine qualities of my father’s deeds and the ugly affections to which my mother was subject, I was moved to warmth and love for the former, and avoidance and hatred of the latter. I observed a very great difference between my parents in this respect; and so too in the fact that my father never appeared distressed at any setback, while my mother would suffer grief at the smallest occurrence. You probably realise yourself the way in which children imitate those things in which they take pleasure, but avoid what they do not enjoy watching.¹⁰¹

Aff. Pecc. Dig. 8, 27.22-28.8 DB = V.40.15-41.9 K.

The superlatives used to refer to the character traits of the father and the mother emphasise the extreme nature of each one’s behaviour, in a positive and a negative light respectively. Above all, the graphic description of the mother’s conduct, with its focus on the way her passions are enacted through biting, shouting and fighting, is suitably linked to the disapprobation of her attitude on Galen’s part, who aesthetically calls her affections ‘ugly’, as opposed to his father’s ‘fine’ deeds. Jim Hankinson has emphasised the pointed use of the ethically-related terminology assigned to the two parents, referring to the father’s deeds (erga) as opposed to the mother’s affections (pathē), to highlight that the power of voluntary action in Galen is specific to the rational soul.¹⁰² The same, I think, can be said about another key element in the above passage, namely that Galen, from the standpoint of a moral recipient this time (and not a moral leader), is cast as able to embrace or avoid a pattern of behaviour only after careful observation and critical parallelism of moral positions he encounters in others (παράλληλά τε ὁρῶντί μοι).¹⁰³ Therefore, deliberate individual decision-making, especially by closely examining opposing morals, is a crucial part of sober philosophical teaching and learning (see also Chapter 3).

Critical thinking is indeed presented as a constant in the process of moral education. This is demonstrated both by the fact that Galen’s father conducted, on his son’s behalf, a scrutiny of the lifestyle and doctrines of Galen’s teachers (τοῦ τε βίου καὶ τῶν δογμάτων ἐξέτασιν, Aff. Pecc. Dig. 8, 28.17-19 DB = V.42.3-4 K.) and by the fact that in a speech put into the mouth of Galen’s father in this context, the paternal figure advocates cautious study and judgment of philosophical approaches that will help Galen increase his virtues of justice, self-control, courage and independent thinking (Aff. Pecc. Dig. 8, 28.25-29.6 DB = V.42.11-18 K.). The combined ethical and intellectual excellence of Galen’s father squares with the traditional way a philosopher would normally be identified in the Imperial period.¹⁰⁴ This explains why Galen is eager to reproduce his father’s distinctive features also in Good Humour and Bad Humour, where this time the emphasis is on the extent to which his father, in fact, exceeds the traditional philosophical model: ‘My father reached the point at which he was extremely competent in geometry, architecture, arithmetic, mathematics and astronomy, and admired by everybody who knew him for his justice, goodness and temperance – like none of the philosophers.’¹⁰⁵

The beneficial impact of Galen’s father on him is given some prominence as the text proceeds, through a description of the moralising dynamics between the two parties. We read that Galen took specific instructions (my emphasis) from his father which he still observed (ἐγὼ παρὰ τοῦ πατρὸς λαβὼν τὰς ἐντολὰς ἄχρι δεῦρο διαφυλάττω, Aff. Pecc. Dig. 8, 29.13-14 DB = V.43.6-8 K.), that (like his father) he is fond of making a vigorous and thorough examination of philosophical material (σπουδῇ πάσῃ ἀκριβῆ τὴν ἐξέτασιν ἔχω, Aff. Pecc. Dig. 8, 29.15 DB = V.43.9 K.), he follows the moral principles of despising reputation and esteem which his father accustomed him to (δόξης τε καὶ τιμῆς ὁ πατὴρ εἴθισέ με καταφρονεῖν, Aff. Pecc. Dig. 8, 29.18-19 DB = V.43.13-14 K.), remains unshaken by sudden events because this is the quality he observed in his father (ἀνέκπληκτός τε πρὸς τὰ κατὰ τὸν βίον ὁσημέραι συμπίπτοντα διαμένων, ὥσπερ ἑώρων τὸν πατέρα, Aff. Pecc. Dig. 8, 29.15-16 DB = V.43.9-11 K.), always recalls the paternal counsels handed down to him (μεμνημένον ὧν ὁ πατὴρ ὑπέθετο, Aff. Pecc. Dig. 8, 30.10 DB = V.44.10-11 K.) and was influenced in his decision-making concerning moral issues by how his father would define things, in this case as regards the primary point of material possessions (τοῦτον γὰρ ἐτίθετο πρῶτον ὅρον ἐκεῖνος κτημάτων, Aff. Pecc. Dig. 8, 30.12-13 DB = V.44.13-15 K.). I have gone into some detail about the textual evidence relating to the educational role of Galen’s father (italics mine), because I see interesting connections with the way Galen depicts himself throughout the text but also in this context as practising precisely those qualities that shaped his character and contributed to his ethical advancement. Towards the end of the section on his father, Galen addresses the recipient of the essay thus:

Therefore cultivate the argument that I have stated, to this end; remember it, and practise it constantly, investigating whether or not I have spoken the truth, until finally you are as completely convinced of it as of the proposition that two times two is four.¹⁰⁶

Aff. Pecc. Dig. 8, 30.18-21 DB = V.45.4-6 K.

Regular practice, a good memory, study and careful examination are all recommendations appended to Galen’s educational profile, derived from his father’s pedagogy, as he himself described it above. The concluding sentence almost coerces the recipient into believing that his moral success is guaranteed only if he follows Galen’s advice, just as Galen managed to become the perfect exemplum through his apprenticeship to his father, his own paradigm. Although traditional in other works of self-improvement (e.g. Plutarch, De Prof. in Virt. 84E; Seneca, Letter 52.2–3), moral emulation in this Galenic context transcends the textual limits of his work, reflecting the author’s anticipated or envisaged role as a moral teacher within his society.

Insatiability as the aetiology of grief

We have seen in Chapter 4 that in his Avoiding Distress, Galen negotiates the passion of grief (lypē) that arises from the loss of significant material or other possessions. In the Affections and Errors of the Soul, he turns his attention to another factor that triggers grief, one that is most appropriate to the upper-class inhabitants of the Roman Empire that he has in mind, i.e. insatiably coveting material possessions.

To begin with, we should note that in this context Galen conceptualises insatiability as ‘the most wretched affection of the soul’ (ὀρθῶς εἰρῆσθαι πάθος εἶναι ψυχῆς μοχθηρότατον ἀπληστίαν, Aff. Pecc. Dig. 9, 34.16-18 DB = V.51.13-14 K.) and the foundation stone of a series of interrelated moral vices, such as love of money, love of reputation, love of esteem, love of power and love of quarrelling (κρηπὶς γάρ τις αὕτη φιλοχρηματίας ἐστὶ καὶ φιλοδοξίας καὶ φιλοτιμίας καὶ φιλαρχίας καὶ φιλονεικίας, Aff. Pecc. Dig. 9, 34.18-19 DB = V.51.14-15 K.). This definition of insatiability, which implicates moral condemnation, reflected in the ethically loaded term μοχθηρότατον, progresses into an associated explanation of the passion, which is calculated to arouse even stronger feelings of revulsion in ancient readers: Galen defines the synonym acquisitiveness (πλεονεξίαν) as the foundation (κρηπῖδα) of ‘shameless, wanton, tyrannical mistresses’ (αἰσχραῖς καὶ ἀσελγέσι καὶ τυραννικαῖς δεσποίναις), referring to love of money, meanness, love of reputation, love of power and love of esteem; and emphasises how socially repellent (αἰσχρόν) it is to care for our legal freedom, yet neglect our genuine, natural freedom by turning ourselves into slaves to the above mentioned vices (Aff. Pecc. Dig. 10, 35.15-20 DB = V.53.7-13 K.).

Beyond the theoretical definitions of insatiability provided by Galen and the way they are meant to create feelings of revulsion against this vice by stimulating the readers’ self-esteem, as we have seen, there is another tactic at play here, i.e. seeking to prompt Galen’s audience to visualise the destructive effects of insatiably feeding the body. This is used as a parallel to the insatiability of the soul. The relatively long physiological description of digestion offered here (Aff. Pecc. Dig. 9, 31.1-12 DB = V.45.8-46.5 K.)¹⁰⁷ is probably the most scientific Galen can get in this essay, giving us for the first time some sort of a glimpse into his identity as a physician.¹⁰⁸ In particular the level of technical detail and the provision of bodily symptoms of indigestion such as diarrhoea or the creation of bad humours in the veins are a window on the author’s medical theory of nutrition, as expounded elsewhere in his corpus.¹⁰⁹ This is not to say that Galen breaks the philosophical illusion of his Affections and Errors of the Soul, for he is still conscious that he is addressing an audience only some of whom would perhaps have had some tangential knowledge of medicine. That explains his insertion of explanatory asides such as ‘the symptom is known as diarrhoea’, which shows that Galen makes this technical section reader-friendly to non-experts in physiology or medicine, keeping up with the readership conventions of popular philosophy targeting a wider elite audience.

Yet, what makes the section on nutrition important from a moral point of view is that it gives prominence to two key notions relating to the function of nutrition, which are transferable to the understanding of the proper function of the soul: viz. attention should be paid to a) ‘what is moderate’ (τὸ σύμμετρον), which is defined on the basis of b) what is necessary (χρεία) or useful (ὠφέλεια) for the body/soul.¹¹⁰ Overloading the body with unnecessary foodstuffs is likened to lusting after possessions such as pearls, pieces of sardonyx and other precious stones, garments interwoven with gold or made of silk. Galen is here insinuating that these material goods are not conducive to one’s psychic health, because they promote uncontrollable greed, and so he provides another inventory that groups together possessions beneficial to the body, to help readers understand the kind of thing they should really be after in taking care of their soul: i.e. objects by which we are nourished, clothed or shod, houses, and things which are of use to the sick such as olive oil (Aff. Pecc. Dig. 9, 31.12-26 DB = V.46.5-47.5 K.). By establishing, through this parallelism, the quantitative principle in the possession of goods, just like his father had done in Aff. Pecc. Dig. 8, 30.12-13 DB = V.44.13-15 K. as noted above, Galen also draws a line between things we should opt for, if we are wise, and others we should not. So while the possession of one pair of shoes is necessary and useful, the possession of another five or ten pairs is superfluous and useless (περιττόν τε καὶ ἄχρηστον, Aff. Pecc. Dig. 9, 32.2-3 DB = V.47.7-8 K.), and the same goes for clothing, servants and utensils. This distinction in a sense echoes the Stoic demarcation between preferred and dispreferred indifferents, which I think makes more sense in a subsequent passage, where Galen defines the opposite of covetousness, i.e. self-sufficiency, as being really ‘up to us’ (ὅπερ ἐστὶν ἐπὶ σοί), a factor we can control in Stoic theory, unlike wealth which is the result of luck and not virtue (Aff. Pecc. Dig. 9, 33.20-22 DB = V.50.1-4 K.). Galen’s moral advice in favour of self-sufficiency, however, is not unpragmatic by recommending, for example, an ascetic attitude to external goods. It is noteworthy that, because he himself, as well as his immediate and implied audience, comes from the aristocratic echelons of Imperial society, it would have been paradoxical to propose eliminating externals in line with an Epicurean or Cynic perspective. What he suggests instead is staying within certain boundaries in line with the criterion of usefulness.¹¹¹

The text makes it clear that Galen is a practical man in the society in which he lives and writes. He appreciates the high standards and expectations people from his class have, namely the possession of additional wealth and their aspirations for social and political recognition, and advises accordingly. His teaching is also enmeshed in social critique of his class (a common feature of his moralism, as we will see in the next two Chapters), targeted especially against those who have embraced a life of indulgence (τὸν ἀπολαυστικόν … βίον, Aff. Pecc. Dig. 9, 32.9-10 DB = V.47.15-16 K.), spending up to thirty times more than necessary.

Self-projection also shines through in this section, as Galen again becomes a paragon for the addressee. Although both parties are described as having equal opportunities as regards the possession of and access to material wealth (Aff. Pecc. Dig. 9, 32.5-8 DB = V.47.10-15 K.),¹¹² the author sets up a glaring contrast between them: Galen is not distressed when he spends his inheritance discharging other people’s debts, nor when he does not put aside any surplus amount, whereas the addressee does suffer distress, despite his property growing and his not spending any money on good works or investing in the purchase of books or the training of scribes (Aff. Pecc. Dig. 9, 32.12-33.2 DB = V.48.1-16 K.). Perhaps one reason for Galen’s cheerfulness is that he indulges in ‘moral’ investment, notable euergetism, unlike his addressee, as the text makes clear. That is consistent with Galen’s ensuing reprimanding of the addressee with the remark that the latter’s insatiability is out of control, since he is not content with being even richer than 120,000 other people, but wishes to be the wealthiest person of all. Galen concludes that by adopting this attitude, the addressee will be perpetually ‘poor’ because of his boundless desires. So what he proposes is that the addressee should persuade himself that he is rich and so he need not be distressed over any financial losses. The same result will come about if the addressee rationalises his greed for esteem (Aff. Pecc. Dig. 9, 33.28-34.16 DB = V.50.10-51.13 K.).

The psychotherapeutic training proposed by Galen rests primarily on the use of doctrines concerning the importance of self-sufficiency as opposed to the dangers resulting from greed. Galen considers the application of such doctrines a secure pathway to freedom from distress, as he regards this technique as being ‘entirely up to us’ (πᾶν ἐφ᾽ ἡμῖν, Aff. Pecc. Dig. 9, 34.23-24 DB = V.52.3-4 K.). On another level, however, the use of suitable doctrines also has implications for the way Galenic psychotherapy is presented as simple, optimistic and accessible to all. Galen is clear that people who had not had the chance to be trained in similar doctrines in their early education should not despair, because now they could follow Galen’s suggested path (Aff. Pecc. Dig. 9, 34.26-35.2 DB = V.52.7-9 K.). Therefore, Galen’s pedagogical burden is presented as a decent counterpart to early training for any late comers. His moral agenda is also reachable to a wide group of people because, as the text suggests, Galen developed his ethical discourse not just to his addressee but also to many others on subsequent occasions, persuading them and bringing long-term moral benefits (Aff. Pecc. Dig. 10, 35.5-7 DB = V.52.13-16 K.).

A short story is inserted here to drive home the point. It concerns a man prone to luxury, sex, love of reputation and esteem who suffers from grief because he cannot satisfy his desires, given that he is not wealthy. Having observed Galen’s cheerfulness, he asks him to teach him how to overcome grief. But the story makes clear that Galen is unable to help this person, since it takes a lot of time to heal deeply rooted passions (Aff. Pecc. Dig. 10, 35.26-36.9 DB = V.54.3-14 K.). Although Galen sympathises with people who have moral failings, in his suggested psychotherapy sudden character change is not an option (as it is not elsewhere, e.g. in Plutarch).¹¹³ This substantiates Galen’s warning about maintaining moral alertness and proactiveness. Finally, this story also points to what Galen sees as a desirable social response to ethical progress in other people. The emphasis is on it being in everyone’s interests to have healthy companions to associate with, since these will become beneficial friends (Aff. Pecc. Dig. 10, 36.10-13 DB = V.54.15-55.1 K.), therefore providing a humanistic perspective through which to approach moral development.

Conclusion

The Affections and Errors of the Soul is the longest of Galen’s surviving ethical works and therefore provides us with unprecedented insights into the author’s moralising endeavour. Compared with other ancient moral works treating the well-being of the soul and especially the therapy of anger and greed, it might seem unsophisticated to modern tastes: its psychotherapeutic discourse is not as refined as that developed by Seneca or Plutarch, for example. The essay has far fewer quotations and proverbs from popular or high philosophy and therefore seems to be lacking the necessary trademark of a popular philosophical treatise; it shows signs of sloppy repetitions of the practical rules one should follow to achieve self-mastery, and the author’s moral outlook in this respect might look hard to understand in terms of its overall structure and occasionally its content. Having said that, it is likewise important to note that this work is a serious attempt on Galen’s part to enter the realm of practical ethics without being a professional luminary in this area. He is the first doctor to offer a systematic psychotherapy by means of popular philosophical essays and to occupy himself with the wider area of practical and not just medical ethics. Consequently, any modern scholarly approach that assesses the work only on its form and register is unlikely to be helpful or, for that matter, conducive to an overall appreciation of the Galenic moral ontology.¹¹⁴ Indeed, it is the idiosyncratic character that Galen brings to the essay and which is an integral part of a distinctively Galenic moral discourse that should be at the centre of modern scholarly appreciations.

In this Chapter we have encountered a wide range of moralising devices utilised by Galen in a kind of life coaching aimed at restraining wild passions. This is the sort of teaching an upper-class member of society was expected to benefit from through the contemporary Hellenic literary culture (paideia), which equipped them with the capacity for rational, philosophical self-management. As we have seen, for Galen it is not simply important to list what the moral agent can or should do to achieve happiness, but also to engage their good will, encourage critical thinking and learning through imitation of model persons and attitudes, even if, on occasion, that meant using rhetorical manipulation, evoking an over-inflated sense of self-authorisation or a cynical approach to expose moral defects. These are all part and parcel of Galen’s project of philosophical therapy, which catered to an audience with a highly developed awareness of social honour/shame, as we have seen. This puts him in a position to play with the social expectations of his elite audience by inculcating in them appropriate moral patterns so as to regulate their character. For example, we have seen that overreacting in anger or being greedy are key pieces of moral advice for the educated audience of Galen’s era, who were expected to be self-composed instead.

The very last section of Book 1 of the Affections and Errors of the Soul is enlightening in bringing out the staples of Galen’s ethical programme: given that self-absorption extinguishes discernment and good decision-making, it is necessary to consult judicious councillors on important issues. These people should be fearless in expressing their criticism openly, which the moral agents should be willing to accept with gratitude. However, it is in the end up to the agent to reach a state of self-realisation and to use the power of reason to monitor any bewildering passions. Although in other parts of the work, Galen highlights the destructive effects of self-love, in the conclusion love of self is exonerated from blame as being a crucial step towards truly becoming a noble person and not just appearing to be one. A significant element of Galen’s moral perspective is that the agent should never lose hope in the process of moral correction, which ties in with the optimism we have observed elsewhere in the text (Aff. Pecc. Dig. 10, 36.14-37.23 DB = V.55.1-57.3 K.), despite the fact that advanced age or other factors are sometimes seen as an impediment to moral improvement.¹¹⁵

Even more interesting is that the concluding section re-introduces some key moralising means Galen has stressed just before the end of the essay: anamnesis, in the sense of recollection of critical moral advice, chastisement, encouragement and setting up moral models are all components which Galen has exploited in his text. He has reminded his addressee of autobiographical incidents from his own youth, scolded him for being greedy, advised him to place himself under the guidance of an advisor and later encouraged him to develop self-understanding. And all this Galen did while setting himself up as a paradigm for his readers. The depth and breadth of Galenic moral geography and his creative adoption and adaptation of traditional popular philosophy is what marks it out as an important contribution to the history of Graeco-Roman practical ethics.

Chapter 7 Recognising the Best Physician

We have seen in other parts of this book that, in contrast to mainstream trends that disputed the cultural significance of medicine in the Roman Imperial period,¹ Galen ranks it as the highest of the liberal arts, mostly by emphasising its positive moral role. For him medicine is a lifelong calling which contributes to man’s ethical improvement, releasing him from his bestial, sub-human nature (Protr. 14, 116.20-117.18 B. = I.38.9-39.10 K.). His naturalistic works, as shown in Chapter 2, even put medicine and the physician centre-stage, linking them to character shaping and the management of detrimental passions. Elsewhere, Galen goes beyond individual ethics to foreground the social advantages of medicine. He asserts that its ultimate aim is to benefit mankind (εὐεργεσίας ἀνθρώπων ἕνεκεν, Opt. Med., 288.5 Boudon-Millot = I.57.10-11 K.) by healing humans through philanthropy (PHP 9.5, 564.30 DL = V.751.17-752.1 K.) or performing acts of kindness (Hipp. Epid. I, 1a, 94.4-6 Vagelpohl). Those practising the medical art who sought personal gain were not true physicians but mere drug dealers (Opt. Med. 291.17-21 Boudon-Millot = I.61.11-15 K.) who, in Galen’s view, distorted medicine’s humanitarian character (Opt. Med. 287.7-10 Boudon-Millot = I.56.10-13 K.). All this shows that Galen conceptualised medicine’s philanthrōpia as an activity with the broadest possible appeal,² an occupation for humanity at large, which buttresses the ethical orientation and impact he had claimed for it.

In Recognising the Best Physician, which survives only in an Arabic translation³ that is generally considered to reproduce Galen’s spirit and letter faithfully, the excellent physician should not just heal sick bodies, but be actively integrated in the community he lives in in ways that will be explored later. Although this kindheartedness may at least in its essentials go back to the Hippocratic tradition, mainly the deontological works of the later Hellenistic period Precepts (esp. ch. 4), On Decorum or Physician (ch. 1), Galen reinvigorates the notion by transposing it from a purely therapeutic context into a societal and civic one. Even the Hippocratic Oath was designed for a restricted fraternity of physicians,⁴ whereas Galen’s popularising works⁵ (whether medical or philosophical) tend to position the function of medicine in a broader communal framework.⁶ Galen is acutely interested in participation in public affairs, in the cooperative interaction between fellow-citizens,⁷ as well as in how medicine could play a significant role in ensuring the uninterrupted fulfilment of political activity and civic duties.⁸

Recognising the Best Physician purportedly discusses the importance of prognosis as a branch of medicine, but pretty much like Prognosis, it has little to say about prognostic theory per se⁹ and more about public critique. The malfunction of the medical community is presented as a reflection of wider social corruption, and unskilled doctors are given the same traits as the ‘wicked orators’ familiar from the analogies Plato uses to represent and categorise oratory and orators. Galen emulates those analogies to suggest that the ideal kind of medicine to combat public disorder is the one professed and exercised by himself. In this work, Galenic medicine, I argue, becomes a sanctioned form of politics and is intended to be a moralising means towards the reintroduction of social harmony in Antonine Rome.

The flatterer-physician

Recognising the Best Physician was initially delivered as a lecture in front of Galen’s students and followers. Its extempore performance seems to have been instigated by Galen’s dissatisfaction with the situation in Rome, which he portrays by means of his favourite antithesis between an idealised past and a debased present. His nostalgia, symptomatic of Second Sophistic literature, arises in this instance from the low esteem in which medicine was then held, and from the paradox that patients did not bother to distinguish between good and bad physicians, despite regarding bodily health as the most desirable of external blessings (Opt. Med. Cogn. 1, 47.11-12 I.). Although the prefatory section of the treatise suggests that the work’s target audience are upper-class Roman patients,¹⁰ further on in the text Galen admits in programmatic fashion that his book proposes to expose the defective therapy offered by crooked physicians (Opt. Med. Cogn. 3, 53.19-21 I.). It is thus reasonable to argue that patients might simply be a pretext audience for a work that is also meant to engage in polemic with the author’s enemies. In fact, as we shall see, Galen’s vitriolic rhetoric, which is part and parcel of his social commentary, makes most sense when seen as a weapon to be used against his peers. Another piece of evidence that the audience of the work has been deliberately blurred or merged is that in his narrative Galen intertwines both lay and scientific criteria for distinguishing the skilful physician. The first category includes largely moral traits that would have been easily identified by non-medical experts, e.g. aversion to luxury or flattery, whereas the second group lists qualifications specific to medical professionals, such as an aptitude for clinical diagnosis and prognosis, a full grasp of the demonstrative method and a profound knowledge of ancient medical authorities.

From an early point Galen, in negotiating social attitudes to medicine, presents the wrong choice of a physician on the patient’s part as a miscalculation influenced by the perverted nature of their environment. Some physicians are chosen on the basis of their personal associations with patients, their socially respectable clientele or their economic standing, yet others on the recommendation of servants and members of their retinue, but never, as Galen protests, after practical testing of their skill or examination of their medical background (Opt. Med. Cogn. 1, 43.10-45.4 I.).

The ignorance which Galen ascribes to his contemporaries renders them easy prey to wicked doctors, who despise medical instruction, since they can safeguard their station by manipulating their patrons instead. Galen’s description of the physicians of his time shows them as flatterers, who are devoted to ‘the hunting of beasts’ and liable to change in accordance with whatever favours they were seeking (Opt. Med. Cogn. 1, 45.5-16 I.). The tricks of charlatans are even tailored to the desires of their pleasure-seeking patients, whom they provide with pleasurable regimens (Opt. Med. Cogn. 1, 45.16-18 I.), undermining the authentic function of medicine that as a rule treats through unpleasant or painful means.

The issue of flattery, which, as we have seen in the previous Chapter, had already become a conventional topic for essay-writing before Galen’s period, is treated extensively by Plutarch in his work devoted to this topic, namely On Friends and Flatterers. Here Plutarch, in stressing the flatterer’s dissimulation, which aims at pleasing his victim (De Adul. et Amic. 51B-D), contrasts him to the doctor who preserves health in fairness and truth rather than through deception and fictional delights (De Adul. et Amic. 61D-E). Plutarch also argues that the flatterer’s alleged assistance, in stark contrast to the doctor’s sincere mediation, is always prompted by arrogance and self-interest (De Adul. et Amic. 63D), in the same way that in Galen the flatterer-physician’s goal is to gain personal power and prestige (Opt. Med. Cogn. 1, 45.21-47.9 I.).

The stereotypical type of the flatterer, however, can be traced as far back as Plato’s Gorgias, where his public performance is inextricably linked to civic affairs, and his area of action is none other than statesmanship. In the last section of the dialogue, Socrates proceeds to a classification of what he calls crafts (τέχναι) and ‘knacks’ (ἐμπειρίαι). Crafts, based on accurate knowledge of a subject, benefit the soul or body. One example is medicine which cares for the body, and its counterpart politics that cares for the soul. Knacks, on the other hand, produce pleasure, are based on mere imitation of crafts and are therefore forms of flattery. The knack that imitates medicine is pastry-baking, while the knack imitating justice (part of politics) is rhetoric (Gorg. 464b-465e), as can be seen from the following table drawn up by Moss:¹¹

Table 1: Crafts and knacks for the body and the soul

	Body		Soul
Beneficial craft	Medicine	Gymnastics	Justice (part of politics)	Legislation (part of politics)
Flattering knack	Pastry-baking	Cosmetics	Rhetoric	Sophistry

The analogy involving the doctor and the politician as representatives of genuine crafts contrasted to the orator-flatterer is further elaborated later in the dialogue, when Socrates becomes irritated by his interlocutor Callicles, and especially by his absurdity in asking him to act as flatterer:

Socrates: Then please specify to which of these two ministrations to the state you are inviting me: that of struggling hard with the Athenians to make them as good as possible, like a doctor, or that of seeking to serve their wants and humour them at every turn? …

Callicles: I say then, the way of seeking to serve them.

Socrates: So it is to a flatterer’s work, most noble sir, that you invite me.

Gorgias, 521a-b; transl. mine¹²

The Platonic background sketched above was well known in Galen’s times¹³ and surely could not have escaped an erudite mind such as his, given his ample familiarity with the Platonic corpus. Galen, nonetheless, seems to be revising the Platonic schema by dissociating Plato’s doctor from the model of the upright politician, as in the passage above, and coupling it with the negative example of the flatterer-orator, so as to make it fit his own view of contemporary doctors as sordid flatterers. Apart from reflecting his imaginative spirit on a discursive level, this change of emphasis must also have had a practical dimension, since it resulted from Galen’s dissatisfaction with what he considers a peculiarity of Roman society in his day: due to overpopulation, which has led to individual seclusion (not even one’s neighbours will notice when one is dead, Opt. Med. Cogn. 1, 47.6-8 I.), physicians could easily escape punishment if their patients passed away because of poor treatment. This highlights a serious issue in the medical culture in Rome at the time, since choosing a scammer rather than a qualified physician could have proved fatal. It must have been relatively easy to run such a risk, given that medical practice was not officially controlled and the therapeutic options available to a patient were literally innumerable. Galen’s rage at the bad faith of celebrated doctors in Rome is deeply rooted in his Prognosis as well, especially in his interesting exchange with the philosopher Eudemus, as we shall see in more detail in the next Chapter. In the mode of a moral preacher, Eudemus explains to Galen that the conditions in Rome incite the wickedness that is widespread in the metropolis (unlike in the innocent countryside or the Roman provinces) and he first presents physicians as criminals, who despite committing the severest offences always escaped detection, and then, as bandits (λησταί) who ravaged the city, conspired against it, and ultimately threatened social justice (Praen. 4, 90.10-92.20 N. = XIV.621.2-623.14 K.). Galen’s assessment of physicians in Rome is consonant with Plato’s categorisation of orators and sophists as flattering detractors of justice and legislation (the two arms of politics). On the other hand, the overpopulation that Galen stresses in both accounts as having engendered the malfunction in the Roman state and more especially the moral anomaly in medical circles is reminiscent of Aristotle’s Politics (VII, 4: 1326b2–25), where overcrowded cities are equated with ungovernable ones. The rich philosophical backdrop of Galen’s text up to this point paves the way for a more dynamic dialogue with the philosophical tradition of the classical past concerning the social function of medicine. I will now attempt to show that the Platonic metaphors are not ad hoc literary devices contributing to the embellishment or elucidation of his narrative, but authoritative means in seemingly technical passages on medical theory and practice that help Galen articulate his concept of an ethically elevated medicine as the counterpart of politics.

The skilled helmsman-physician

Galen’s engagement with Platonic imagery pertaining to politics continues on another level, when he dwells on the extent to which the physicians of his period underestimated Hippocrates, especially as regards the prognostication of clinical cases. In order to exemplify how vital it is for the good physician to be able to foretell future eventualities, Galen compares him with the good helmsman, who, on the basis of indicative signs, can predict violent disturbances in the sea long before they occur (Opt. Med. Cogn. 2, 49.4-17 I.). The helmsman image was already established as a model of guidance and leadership in Presocratic philosophy,¹⁴ yet the way it is used by Galen looks back specifically to the Republic, where steersmanship is considered a craft (Resp. I.341d2–3, II.360e7–8, VI.488b4–5, VI.488d4–7). Galen seems well aware of that, in view of his own exegetical remark in his Doctrines of Hippocrates and Plato that the first book of the Republic offers many instances of the analogy between the physician and the helmsman as skilled practitioners of two beneficial arts (PHP 9.5, 564.10-12 DL = V.750.10-13 K.).¹⁵ In this passage from PHP, Galen goes a step further in classifying physicians according to their objectives (‘lover of mankind’, φιλάνθρωπος, ‘lover of honour’, φιλότιμος, ‘lover of fame’, φιλόδοξος, ‘money-maker’, χρηματιστής),¹⁶ only to conclude that medicine should not be driven by desire for fame or profit, hence endorsing only the first two classes of doctors. Again the idea of social benevolence that Galen praises in the case of medicine through the image of the helmsman relates to Plato’s political philosophy, in which the helmsman is a symbol of the philosopher-statesman and the proper steering of his ship a representation of a well-ordered polis (Republic VI.489a4–6, 489c4–7).¹⁷ By making this simile a central one in his treatise and going on to provide a number of case histories in which, unlike rival physicians, he alone is able to prognosticate in the mode of a good helmsman, Galen is trying to present himself in the light of an ideal physician entrusted with a humanistic vocation, promoting order in the social and moral arena.¹⁸

Galen’s Platonising self-advertisement becomes his main strategy in exposing the debasement of his colleagues. As the majority of physicians covered their theoretical ignorance under a pretence of empiricism, they ridiculed the proponents of prognosis, started contentious debates with them and conspired against them until they provoked some shocking political response, as evinced in the banishment from Rome of the Hippocratic celebrity doctor Quintus (Opt. Med. Cogn. 3, 53.8-19 I.).¹⁹ The activity of malicious physicians, who, according to Galen’s description, operated as an organised group in order to annihilate their rivals, has political connotations that correspond to notions of power. Although they are not the appropriate persons to take political decisions of this sort, they nevertheless do so, led on by audacity and wickedness, just as in the Gorgias Socrates and Polus are surprised²⁰ by the influence of orators who are depicted as having the same ‘privileges’ as tyrants: they can kill, confiscate the possessions of and banish indiscriminately any citizen they choose (Gorg. 466b-e).

The political colouring of medical therapy features most prominently in Galen’s account of correct and incorrect prescription, which – on the basis of how it is described within the text – can reasonably be imagined as a lively interaction between physician and patient: the former orders the latter to accept his dietetic prescription or, if the patient resists, prevents him from following alternative eating regimes inimical to his health (both techniques are practised by Galen, Opt. Med. Cogn. 3, 55.22-23 I., Opt. Med. Cogn. 3, 55.26 I., Opt. Med. Cogn. 3, 57.2-8 I.). The physician’s success in restoring health depends on the extent to which the patient will obey his instructions (Opt. Med. Cogn. 3, 55.5-6 I.), which in turn can result in public esteem for the physician or conversely social disgrace (Opt. Med. Cogn. 3, 55.5-14 I.). Apart from echoing the coercive aspects of public speech not only in Athenian but also in Roman Imperial politics, the impact of a physician’s persuasive abilities on the medical encounter also evokes the ambiguous qualities of rhetoric as discussed in the Gorgias. There Gorgias claims that the orator is endowed with the ability to convince both judges and the body politic in every public assembly²¹ and thus is superior to doctors and other specialised craftsmen even in areas outside his expertise.²² For that reason Gorgias maintains that the orator has the power to ‘enslave’ the doctor (δοῦλον μὲν ἕξεις τὸν ἰατρόν, Gorg. 452e), providing the example of how he, as an orator, was able to persuade the patients of his brother, the physician Herodicus, to accept certain drugs in instances where the latter was simply unable to do so (Gorg. 456b-457c). Gorgias’s rhetoric endows him with immeasurable (political) authority. However, the way in which Socrates argues against Gorgias’s position is very similar to Galen’s refutation of his wicked colleagues, for both men complain that unskilled individuals, whether orators or bad physicians, prevail not due to genuine knowledge but on account of fakery and tricks that help them persuade their audiences (Gorg. 457c-458b). Galen returns to those same Socratic notions at a later point in his treatise and develops the Platonic notion of ‘slavery’, mentioned above, by introducing his own concept of the servility of medical impostors:

Others who practice this art falsely will be found to be greatly esteemed among the households of wealthy men. In view of their inability to ensure anything valid (in therapy), they never request their patients to obey and follow their lead. Instead, they debase themselves to the status of the slaves of their patients. They obey and assist their patients in fulfilling their desires; their intention has never been to direct them towards what is most agreeable and useful because they are ignorant of any such knowledge. They satisfy the desires of their patients in the most pleasurable things, according to whatever the individual case may be, thus reaching the utmost depth of servility. In doing so they become wicked slaves whose services are useless, and indeed harmful.

Opt. Med. Cogn. 5, 77.20-79.4 I.; transl. Iskandar

Galen’s polemic against his enemies on the issue of servility informs his self-characterisation to a large extent, stressing as it does his own credentials that his enemies so sadly lack. Galen alone is in a position to treat his patients appropriately by applying his infallible medical prowess, not tricks; should the patient obey, his health is always restored, but those who disobey suffer severely (Opt. Med. Cogn. 3, 55.25-57.16 I.). That Galen exalts his medical practice through moral means is especially evident in the ethical evaluation to which he then subjects it, claiming that good men possess medical skill in contrast to bad men who do not (Opt. Med. Cogn. 3, 57.16-18 I.). This statement – however crude it may appear to modern eyes – is very close to the spirit of the Gorgias, in a passage where Socrates refuses to accept that the non-skilled man knows what is good or bad, beautiful or ugly, fair or unfair (Gorg. 459d).

The exceptionality with which Galen furnishes his medical profile is a motif developed further in the narrative. A sequence of delightful case histories are elaborated, all of which explain why those witnessing Galen’s medical achievements called him a ‘wonder-worker’ and ‘wonder-teller’ (Opt. Med. Cogn. 3-4, 59.18-63.14 I.). What the stories themselves put across very strongly is Galen’s pride in his prognosticating skill by contrast to the shamelessness of inexperienced charlatans (Opt. Med. Cogn. 4, 63.21-67.10 I.), which backs up his initial conceit that no one ever gave such precise prescriptions as he did, and that he alone, due to secure knowledge, has never once erred in his lifetime (Opt. Med. Cogn. 3, 59.12-16 I.).²³

This might cast some additional light on the sophisticated way in which the helmsman imagery is deployed in Galen’s text. Plato uses the simile of the helmsman to illustrate the epistemological status of crafts, considering the helmsman an expert, who just like the doctor, has the critical ability to distinguish between possibilities and impossibilities (τὰ δυνατά vs. τὰ ἀδύνατα) in his art (Republic 360e-361a). Taking into account that medical prognosis is based on possibility just as diagnosis is,²⁴ Galen is in all likelihood resorting to the helmsman analogy to furnish his medical expertise with the tenets of Platonic epistemology, thus shielding it in philosophical prestige. This proposition also explains why, in attacking the Methodists for their lack of any solid knowledge in the Therapeutic Method, Galen effectively compares them to negligent pilots who wreck the ship and then hand over the planking for the passengers to cling to (MM 5.15, X.377.17-378.2 K.). In the context of Recognising the Best Physician, the epistemological underpinnings of the helmsman imagery make sense, especially in the light of the key role that scientific knowledge acquires in the ensuing narrative, and in particular of Galen’s rejection of rhetorical speeches, which (taking his cue from Plato) he considers an enemy to truth, in contrast to the Stoic view in which rhetoric is part of logic, for example.²⁵

Apart from affirming his medical expertise, Galen’s self-image is also designed to challenge the perverted version of medicine practised by his peers. To that end, his self-image is likened to that of Socrates, particularly his self-assertiveness in operating as a performer of authentic politics within his city in his opposition to non-experts:

Socrates: I think I am one of the few, not to say the only one, in Athens who attempts the true art of statesmanship, and the only man of the present time who manages affairs of state: hence, as the speeches that I make from time to time are not aimed at gratification, but at what is best instead of what is most pleasant, and as I do not care to deal in ‘these pretty toys’ that you recommend, I shall have not a word to say at the bar. The same case that I made out to Polus will apply to me; for I shall be like a doctor tried by a bench of children on a charge brought by a cook.

Gorgias, 521d-e

To have a cook, typically offering pleasure in the belly, bring a legal charge against a doctor, who serves the community by devoting himself to its health, is to demolish any sense of social and indeed ethical order. What is more, to have children, who are both rationally unsound and pleasure-prone, determine the outcome of this legal case, is to fight a losing battle. This philosophical baggage implicated in the simile of the doctor and the cook is made part of Galen’s Prognosis (Praen. 1, 74.8-11 N. = XIV.605.8-12 Κ.) too, where it becomes a staple of the author’s self-advertisement in promoting the utility of medicine as opposed to perversely using it to seek to please.

The passage quoted from Gorgias also highlights the connection between the good doctor and the upright politician that is so well suited to Galen’s understanding of true medicine. We see from this passage that, as the best possible statesman, Socrates is aiming at what is best (πρὸς τὸ βέλτιστον), just as in Gorgias 521a-b cited above he was referring to ministering to the city (τὴν θεραπείαν τῆς πόλεως) by struggling to make his fellow citizens as good as possible (ὅπως ὡς βέλτιστοι ἔσονται) in the manner of a good doctor. The moral impact of the real politician or physician is what seems to have inspired Galen so much that he adjusts it to his self-projection as an ideal physician, who brings about stability on a political and ethical level.

Genuine medical art in the service of society

What qualifies someone as a true physician therefore is their skill, which – according to Galen – should be manifested through demonstrative arguments and by using deduction and analogy.²⁶ Galen proceeds to specify that logical abilities should not just be employed by medically inclined men, but also by rich dignitaries and men of power, who must all be able to differentiate between correct demonstration and false doctrines. To be in a position to recognise the good physician then is not presented as a private matter, but as an act of social discernment with broader repercussions, similar, for example, to the application of Aristotelian prohairesis (reasoned judgment), informing not merely personal choices but above all political resolutions. This is also apparent from two related changes of emphasis in Galen’s narrative. First, by the generalised grammatical subject in the following critique by Galen, which describes lack of acumen, lack of knowledge and lack of confidence as all-pervading conditions, relevant to everyone in Galen’s society:

To become acquainted with the tricks of impostors among physicians is an easy task in itself; nevertheless, it has become difficult to do so because nobody is willing to discriminate, to conduct examinations, and to acquire knowledge. I cannot see why anyone who definitely seeks to recognize skillful physicians, … should ever fail to examine them and put them to the test; they lack confidence in themselves, and do not think that they are competent for this (task).

Opt. Med. Cogn. 7, 93.7-14 I.

The wider importance of choosing the best physician is also shown by the next narrative, which deals with the failure of scientific method specifically within a civic context. Here Galen asserts that men of action who ‘run their lives like beasts’ cannot possibly test physicians, because, as he says, they are unskilled and ignorant of the methods of debating, while they also lack self-confidence (Opt. Med. Cogn. 7, 93.13-18 I.). To make his case, Galen adduces a passage from his favourite historian Thucydides, which considers the employment of dialectical arguments²⁷ and reasoning a sine qua non for political interaction (Thucydides 3.42.2: ‘When a man insists that words ought not to be our guides in action, he is either wanting in sense or wanting in honesty’).²⁸ Galen’s version reads as follows: ‘He who rejects words and reasoning, claiming that things cannot be authenticated by them, is either wanting in intellect or, with this (claim), he seeks to acquire authority or has an interest at stake’ (Opt. Med. Cogn. 8, 95.6-9 I.). The quotation from Thucydides comes from Diodotus’s speech to Cleon in the Mytilene debate; although itself very brief, the surrounding context, which Galen knew as he was very familiar with the Thucydidean description of the Peloponnesian War,²⁹ introduces topics we encounter in Galen’s account too, such as rivalry, personal interest as opposed to the common good, prediction of future events based on reason, civic malfunction and flattery employed to win popular favour.³⁰

Medicine and politics are explicitly interwoven in the next case history, which focuses on a young patient suffering from various attacks of fever. This case history marks a turning point in the text, in that it is an elaborated auto-narration accompanied by extensive social commentary. In fact, this is the first case history we come across that is neither hypothetical (Galen conjectures how a clinical case might progress given different diagnoses and treatments, e.g. Opt. Med. Cogn. 3, 53.22-55.6 I.) nor strictly technical (encompassing the sequence: diagnosis, prognosis, therapy and result of the treatment, e.g. Opt. Med. Cogn. 3, 55.25-57.18 I., Opt. Med. Cogn. 4, 61.17-63.14 I., Opt. Med. Cogn. 6, 79.22-85.5 I.). It is also the first case history that fleshes out the social credentials of Galen’s fellow physician involved in the story (a wealthy youth), his intellectual stance (he hates dialectical arguments) and his conflicting response to Galen’s diagnosis (he laughs at and ridicules him, Opt. Med. Cogn. 8, 95.12-13 I.). Another important topic in this case history is the young physician’s medical ignorance, which is progressively linked to his belonging to a circle of flatterers (Opt. Med. Cogn. 8, 97.5 I.). Galen’s response to the group of flatterers-physicians is a philosophical one, for the flatterers’ continuing laughter notwithstanding, Galen, in the mode of a self-disciplined man, replies mildly to expose their lack of education and their intellectual incompetence (Opt. Med. Cogn. 8, 97.6-20 I.).³¹ The scene is infused with dramatic effect, as Galen describes the delirious reactions of his rivals, while Socratic nuances can be detected behind Galen’s remarks that everybody unjustly hated him and attempted to do him harm (Opt. Med. Cogn. 8, 99.4-8 I.).

Galen’s medical authority is hence philosophically tinged and leads him to his penetrating criticism of contemporary society, which he portrays in a markedly moral light. Spurred on by the need to choose suitable physicians, Galen levels an attack against the vices of Roman society, notably luxury, boredom, self-indulgence, the pursuit of wealth, prestige and offices, and neglect of legal duties:

If anybody wishes to examine physicians and put them to the test, this matter will be beyond his reach if pursued without any prior knowledge of medical principles and without the self-discipline to endure lengthy dialectical arguments. None of those who live a life of ease can endure this because each is dominated by luxury and boredom. They are always busy seeking pleasure; from this they do not regain consciousness. This adversity which has befallen the slaves of pleasure who are in this condition is not slight. Some of them are preoccupied with the pursuit of riches and prestige, and seek (promotion to) the first place or to the second or third or other high offices. Many of them, I think, are in pitiful situations. They spend their lives in making rhetorical speeches that are irrelevant to good judgment and the legal duties which they practise; some they deliver before passing sentences, others after, and so forth and so on. If those who take up legal duties and hold high offices were to get genuine education they would be able to omit all this stuff and to adopt shorter routes to the practice of legal duties, and to employ the rest of their lives in doing better things.

Opt. Med. Cogn. 8, 99.10-101.3 I.

Perhaps the most noteworthy point in this extract is the author’s attack on high officials, who have resorted to immoral ways of life owing to a lack of culture that has destroyed their self-discipline and good judgment (Opt. Med. Cogn. 8, 99.21-101.3 I.). Education, Galen proposes, will make politicians more ethical. Although it is debatable to what degree such public controversy corresponds to contemporary reality, as Nutton warns with reference to Lucian’s satirical commentaries (especially the preface to Nigrinus and The Dependent Scholar),³² in Galen’s case we must be somewhat closer than in Lucian’s satires to the true picture, since only a pragmatic framework would have couched Galen’s next observation, if it were to have any actual appeal to readers:

In my opinion, the recovery of a leading citizen from a disease is more rewarding and much better for him than pursuing legal duties and passing judgments between opponents who quarrel all day long over money.

Opt. Med. Cogn. 8, 101.3-7 I.

As is obvious in both the previous extract and this one, Galen pinpoints a major issue for public men: time constraints.³³ He therefore offers them the practical tip of redefining their priorities. He suggests that they minimise their time-consuming duties in relation to menial matters and, after appreciating the value of bodily health, focus their energies on tracking down the most suitable healer for future use. By implication, searching out the best physician is one of those ‘better things’ that Galen advises his powerful readers (current or would-be statesmen) too to engage in, as a way of driving them from wasting precious time and useless commitment to the lowly duties described in the text.³⁴ Self-determination and a discriminating mind are what is needed to get them going, and these are framed by Galen as skills they could cultivate for themselves.³⁵ Hence at the end of the day, it is not as important for them to find the best physician as to actually get involved in the process of research, which, in line with what Galen has already said, will be intellectually rewarding and help hone their critical skills.

Galen is offering his own input as to how concerning oneself with one’s body may lead to readdressing one’s mental and moral priorities (cf. the discussion in Chapter 2).³⁶ Thus, Galen believes that the kind of medicine he is propagating can help combat both lack of education and any associated social disaster. It may therefore be seen as a condoned form of politics, a response to the failed variety that existed in his time. Far from being an unrealistic theoretical model of statesmanship, the type of politics Galen is proposing has practical usefulness in his society, as noted above, although it would be fair to say that his prescriptions in this area do not amount to any kind of positive model for how a good civic community, state or empire should be run (in the mode, for instance, of Dio of Prusa and Plutarch). It is interesting that, even though Galen seems to be doing real moral philosophy in his body of ethical texts, in Recognising the Best Physician or indeed elsewhere he cannot be said to be doing political philosophy in any real sense. Rather, he is seeing everything from the viewpoint of a disgruntled doctor, who is convinced that as long as everyone gets things right as far as medicine and making correct judgments about health and medical practitioners goes, everything else will fall into place, including the correction of public disorder.

That Galen links ethics and politics and accentuates their practical utility in contrast to theoretical philosophy aligns him with similar ideas held in ancient thought (notably in Plato and Aristotle). He confidently declares these connections in other parts of his corpus too. For example, taking his cue from Xenophon’s Memorabilia and Socrates’s views as described in that work, he mingles ethical and political virtues and actions (τὰς ἠθικάς τε καὶ πολιτικὰς ὀνομαζομένας ἀρετάς τε καὶ πράξεις, PHP 9.7, 588.26-29 DL = V.781.6-10 K.). In My Own Doctrines he considers practical, political (πρακτικήν τε καὶ πολιτικήν) and ethical philosophy versions of the same philosophical branch in contrast to the theoretical (Prop. Plac. 15, 138.24-26 PX); just like in the Doctrines of Hippocrates and Plato, he explains that morals and political action taken together (ἦθός τε καὶ τὰς πολιτικὰς πράξεις) are a subject that speculative philosophers will never tackle (PHP 9.7, 588.7-9 DL = V.779.16-780.2 K.).

Autobiography and Galen’s philosophical medicine

In another section of the text, Galen launches a lengthy narration of some key points in his own career, slanted so as to draw attention to the values and virtues that have helped him succeed, and which are thus being held up as good models for others to follow. Thus, he is introducing his idea of moral medicine here that differs so much from the tendencies of his rivals. The latter, due to want of medical skill, behave as self-interested public men, whereas Galen had repudiated worldly pleasure well before embarking upon the practice of the medical art. He explains how, even as a youth he distinguished the profession of medicine from the social and political drudgeries that might accompany it, such as competing for clients, what he calls the ‘burden of going at an early hour to wait at the doorsteps of men, of riding out with them, of waiting for them at the thresholds of kings, accompanying them to their homes, and drinking with them’ (Opt. Med. Cogn. 9, 101.21-103.2 I.). He therefore scorned the Roman custom of salutatio that satirists, for instance Juvenal (Sat. 1.127-146) or Lucian (Nigr. 22, Merc. cond. 30-31) so often debunk.³⁷ Galen also attacks salutation in his Prognosis (Praen. 1, 68.2-11 N. = XIV.599.3-600.5 K.) and Therapeutic Method (MM 1.9, X.76.15-18 K.), regarding it as a severe impediment to both medical education and the emotional equilibrium of the physician, as it is liable to cause him distress (Opt. Med. Cogn. 9, 103.2 I.).³⁸

In order to call further attention to the worldly distractions that could deprive other physicians of their medical skill, he compares them to the orator Herodes, who retained his popularity despite frequently delivering unsuccessful speeches owing to his busy schedule (Opt. Med. Cogn. 9, 113.15-115.6 I.). This parallelism of doctor qua orator leads Galen to refer to the existence of the same paradox in medicine, where again the most highly esteemed physicians seemed to be the less well educated and the busiest ones (Opt. Med. Cogn. 9, 115.3-6 I.). Class fraction may be what Galen is aiming at here, as he sets up a strong divide between himself as an ideal physician, and less accomplished medics and political men or sophists.

It is precisely in the light of his disavowal of the worldly distractions indulged in by other doctors and his own self-righteousness that Galen proceeds to explain why in ca. 157 AD he was chosen to be a physician to the gladiators at Pergamum in preference to older and more experienced colleagues.³⁹ By his own account, the high priest at the gladiatorial school chose Galen for the post because, unlike the others, he was not engaged in useless and time-consuming activities (Opt. Med. Cogn. 9, 103.16-105.1 I.), reminding us of the time-wasting engagements of the high officials and bad physicians he has attacked earlier in the work. The high priest praised Galen for his other moral virtues too: his tireless devotion to useful endeavours and the way he abjured idleness. Galen distances himself from both failed politicians and failed physicians. In his efforts to render devotion to the study of medicine attractive to his audience, he claims that it befits heroes and rich men, and segues into castigating those who are ignorant of the structure of body and soul, but deeply well versed in financial matters regarding their household (Opt. Med. Cogn. 9, 111.5-14 I.). Galen elevates knowledge of bodily anatomy to the same status as knowledge of the human soul, which hints at the close interdependence he sees between soul and body in his medical and philosophical discourse, which, in turn, is in line with his preface to Recognising the Best Physician (Opt. Med. Cogn. 1, 41.5-9 I.). This connection also explains his emphasis on philosophical medicine.

Moreover, this conclusion is further supported by the fact that in closing his essay, Galen argues that he had composed the work in order to respond to those contemporaries who had questioned the interdependence between philosophy and medicine. As already noted, Galen was very proud of the fact that philosophy formed the foundation of medical education, and he takes it to be the defining prerequisite for a complete physician too. Here he juxtaposes rich men corrupted by flatterers to philosophical men who always sought the truth, with Galen’s self-fashioning being hinted at in this case, because so often in his writings he casts himself as a lover of truth, as seen above. In addition to overlapping with his professional self-image, this final delineation of the ideal physician-cum-philosopher exonerates him from some of the darker aspects of his public role, notably self-praise. Although he generally condemns self-praise on the part of a physician, at other times he welcomes it, provided that the cures that have elicited this praise are significant (Opt. Med. Cogn. 13, 131.8-11 I.), just like his own, which have been described extensively in the foregoing text.

His personal self-praise in this work, however, is also linked to the promotion of his idea of the philosophical regulation of medicine. The tract closes with the peculiar case history of the pregnant woman who miscarried. Galen’s medical diagnosis was in that instance so precise that most of those present admired him, but the woman’s husband remained totally unimpressed, despite having witnessed Galen’s successes on other occasions in the past. Galen thus called him a ‘beast’ twice over (Opt. Med. Cogn. 13, 133.9 I., Opt. Med. Cogn. 13, 133.12 I.) and classified him in the same general category as wealthy citizens, great conquerors of cities and nations and powerful statesmen, who were all devoid of powers of thought and prudence (Opt. Med. Cogn. 13, 133.12-14 I.). One wonders whether Galen is here alluding to Roman politicians in particular, reflecting his opposition to Roman imperialism, and thus articulating his own form of resistance as a Greek intellectual under Roman rule. Even if notions of ethnic identity are not clearly involved in this instance,⁴⁰ the way Galen elevates the status of education, acumen and discretion in the area of medicine above that of dominance in political power gives us a glimpse of his personal stance vis-à-vis the socio-cultural structures in which he was active. The philosophical lens through which he envisages the proper application of the medical art was a Greek product anyway, and his subscription to philosophical medicine is precisely what seems to validate his medical contribution rather than that of his Roman colleagues.

Conclusion

Recognising the Best Physician must have been written around the same time as Prognosis (ca. 178 AD) and presumably with similar intent, namely, if not to strengthen, at least to preserve Galen’s standing as an Imperial physician.⁴¹ It is true that one of the main preoccupations of any successful physician in Rome was his social establishment within a cosmopolitan community that contained equally accomplished orators and sophists,⁴² and Henri Willy Pleket is probably right to suggest that the intellectualisation of medicine came about as a result of such professional concerns.⁴³ Galen’s case, however, is more complex than is often assumed, since his engagement with philosophy and ethics in particular has a social and moral orientation that is too dynamic and methodical to be serving only his advancement. It is a firmly entrenched ideology, a strong and honest belief that medicine can change the world not just through healed bodies but above all through reformed minds and characters. For Galen ethics was not a means to an end, but another path, combined with that of medicine, towards social harmony.

In viewing people as both psychosomatic entities and public agents, Galen’s philosophical medicine, steeped in the principles of practical ethics, helps its addressees to combat the challenges of Graeco-Roman society and thus reveals a man sensitised to his socio-cultural surroundings, and eager to contribute in a practical way to public life. The facts of his life show that Galen never entered politics. One reason might have been his aversion to the variety of civic life he experienced in reality, with all the predicaments it involved, as depicted in works such as Recognising the Best Physician. His political input was thus realised not through an active public career, but through his morally-driven medicine, which was empowered with the qualities needed to reform the degraded political community of his time. By the same token, while in other thinkers politics is a crucial site of moral enhancement, dealt with in independent treatises (e.g. Dio of Prusa’s Orations 42‑50, Plutarch’s Political Precepts or Old Men in Public Affairs), Galen did not go down that route. But his Recognising the Best Physician does offer an insight into the moral components of politics, showing how the medicine that Galen personifies can assist Roman politics to attain ethical purity and function efficiently in the interests of the body politic.

Similarly, it is not fair to crudely apply the characteristics of Hippocratic medicine to Galen.⁴⁴ Owsei Temkin has shown that in the fifth and fourth centuries the competitive nature of Greek medicine, which (in contrast to philosophy) was a profession, led its practitioners to wear ‘the philosopher’s dress’ in order to impress their audiences.⁴⁵ Although in Galen’s time medicine was still a competitive occupation, it had developed greatly as a science as a result of the critical engagement with both the Hippocratic and Hellenistic medical traditions, so that its dependence on philosophy would not have been as essential as it was in Classical times. On the other hand, Galen’s production of distinctly ethical works taken together with the many moral(ising) passages we encounter throughout his corpus are a strong testimony to Galen’s inspired relation to moral philosophy and reflects his ideology, as I have argued above. Galen’s wedding of medicine to ethical philosophy, and his self-delineation as a moralist-physician cannot just be the product of self-promotion or eccentricity. Rather it demonstrates his attempt to establish the authority of a distinctive and innovative form of medicine, which takes into account the social conditions of its recipients (whether physicians or patients) and their ethical as well as their corporeal welfare.

Chapter 8 Prognosis

In a time of universal deceit, telling the truth is a revolutionary act.

Quote attributed to George Orwell

Prognosis is a rich source of case histories, centred around Galen’s successful prognostication of illness, something that enabled him to enjoy a high level of professional and social visibility. This has led critics to look at the work as a self-aggrandising piece, promoting Galen’s standing in the competitive medical marketplace as well as in imperial and aristocratic circles.¹ Others have seen it as an example of Galenic autobiography² or prized it for what it has to say about the contemporary historical and cultural milieu, especially in relation to the social position of doctors.³

Yet, on closer reading, these aspects of the work are to a greater or lesser extent caught up with Galenic notions of morality and ethics. And, although this material is scattered throughout the text, it has not hitherto attracted the attention it is due. For example, even though the essay’s generic affiliation with the moral diatribe was recognised as early as the publication of the text’s most recent edition and commentary (in 1979), this merely produced some overgeneralised statements to the effect that Galen’s ethical concerns were a marker of Second Sophistic high culture, and there has been no attempt at further exploration since.⁴

This Chapter aims to delve into the moralising aspects of Prognosis and probe the reasons for which Galen infused this essay with elements characteristic of popular philosophy. What is the role of practical ethics in this self-laudatory piece, and what is the connection – actual, envisaged or otherwise – between medical diagnosis, cure and prognosis on the one hand and philosophical treatment of character and soul on the other? As I will go on to argue, the moral discourse throughout Prognosis may be seen as the forceful medium through which Galen: a) validates his medical and philosophical profile, b) proposes how to ethically regulate the medical profession within society, and, most importantly, c) expounds his moral didacticism on social passions, notably malice (kakoētheia) and love of strife (philoneikia). Far from the inherently eristic and conceited physician he is often perceived to be, Galen depicts himself as a wise moral critic, whose edifying instructions resonate with the readers’ own experience of how to conduct oneself privately and publicly in different situations and settings. Galen does not only advise readers on how to comport themselves in a dignified manner in the company of colleagues and acquaintances, but also on how to take certain virtuous paths through life.

Generic and narrative challenges and prospects

Prognosis encompasses the interpenetration of several literary models, including autobiography and diatribe, as mentioned above, but also the epidemic case history, polemic and refutation and the philosophical dialogue.⁵ The use of the dialogue form in particular is not insignificant. Apart from being the most important form of philosophical literature in this period,⁶ its use in Prognosis is more extensive than in any other work by Galen.⁷ The various conversations are reminiscent of the Platonic exchanges and provide Galen with an array of moralising opportunities, such as the use of direct speech or of philosophical silence.

The style of the treatise is also peculiar in that it mixes philosophical seriousness with humour, wit and sarcasm, as well as occasional comic highlights. Derisive laughter is deployed by a number of malefactors as a way of abusing Galen, whilst at other times Galen himself laughs at other people’s erroneous actions or judgments in order to boost his educational authority.⁸ With the concurrent presence of a ‘laughter of ridicule’ and a ‘laughter of superiority’, stylistic heterogeneity too helps emphasise the markedly moral nature of the work.

Turning to structure, this is even less typical, as the narrative displays disarray,⁹ including digressions that break off the chronological sequence of the story. This is further complicated by the fact that up to chapter 8, which marks the beginning of what has been considered the second part of the essay,¹⁰ the text alternates between sections on medical theory and practice pertaining to prognosis, and sections on social moralising. But I will suggest that some degree of thematic cohesion is detectable, at least in the first half of the work, a suggestion substantiated by the intense emphasis on moral anxieties and priorities.

In terms of narrative texture, the exceedingly vivid accounts are due to a large extent to the fact that Galen is not just the author of the work, but also the intratextual raconteur/rapporteur of the plot (to whom I shall be referring as either the Galenic narrator or ‘Galen’) and at the same time a character/persona, who plays an active part in the narrated encounters.¹¹ Such interfusion may render it difficult for readers to distinguish between fact and fiction in what they read, but as I have shown elsewhere with reference to Plutarch’s sympotic vignettes in Table Talk, this is consistent with the increasing demands of Imperial-period authors for an alert type of reader, who actively contemplates through the process of reading.¹² This is also the case with Galen’s text, as I will show.

A final idiosyncratic feature of the work relates to its main subject. Prognosis is not included in Galen’s bibliographical inventories, so we cannot possibly know in which category of his production he would have ideally placed it. That said, despite the forthright claim of the title to being a work devoted to prognosis, Galen does not consider it a proper treatise on the topic and refrains from grouping it together with strictly prognostic tracts, such as his four treatises on pulse,¹³ Critical Days and On Crises.¹⁴ Therefore to Galen’s mind, Prognosis (pretty much like Recognising the Best Physician) is not a purely medical work, notwithstanding its technical features. The medical interactions between doctors, patients, relatives and associates of patients open up to include a parade of other figures from the highest ranks of Roman and provincial society and politics, especially philosophers, orators and members of the Imperial family, who are more or less interested in discussing moral matters or are the recipients of ethical recommendations. Hence the medical component is, I would argue, a pretext for giving philosophical advice, a framework for Galen’s moralising input.

The distortion of truth

Prognosis starts with Galen’s complaints that the majority of doctors are incompetent in the field of prognostication, since they are completely incapable of foretelling how the illness of their patients will progress. If there is any truth in the ignorance of doctors that Galen describes as a widespread phenomenon in his day (thematised also in Recognising the Best Physician, as seen in Chapter 7), then it could be historically explained by Trajan’s withdrawal of the earlier tax exemptions granted to doctors by Vespasian,¹⁵ which obliged them to concentrate on scrabbling for money instead of educating themselves, and led to the inclusion of half-trained, often illiterate, slaves in this group of medical professionals.¹⁶

Galen communicates this widespread phenomenon with the recipient of his work, Epigenes, an otherwise shadowy figure. We cannot tell with certainty whether Epigenes was a physician himself but, if he is to be identified with the addressee of the Exercise with the Small Ball, he must have been either a philiatros or Galen’s student and social peer.¹⁷ At any rate, the key information that can be gathered about him from Prognosis is that he is a well-off, fellow Pergamene, who has benefitted from an elite education (e.g. Praen. 9, 120.10-12 N. = XIV.651.8-12 K.) and knowledgeable in medical matters. As we will see later on, the set of cultural, philosophical and medical credentials assigned to him enable Galen’s readers to relate to Epigenes and adopt his ethical attitude as depicted in the story.

Now, the intriguing aspect about Galen’s outburst over the physicians’ inability to prognosticate is that he explains its origins in highly moral terms, particularly through the dichotomy between appearing to be (δοκεῖν) and actually being (εἶναι) that is also central to Platonic ethics:¹⁸

For since those who are eager for the semblance of ability rather than the reality have come to predominate in medicine as well as in the other arts, the finest aspects of these arts are now neglected and attention is lavished upon what may bring them a high reputation with the general public – a gratifying word or act, a bit of flattery, a toadying salutation each day of the rich and powerful men in the cities, accompanying them when they go out, staying at their side, escorting them on their homeward journey, amusing them at dinner.¹⁹

Praen. 1, 68.2-11 N. = XIV.599.3-600.5 K.²⁰

The problem Galen identifies is that there is a social preference for appearances over reality, for the surface rather than the essence of things, and that moral agents inclined to these preferences have come to triumph in all the arts, especially medicine. The divide between appearance and truth is a pivotal one in Galen’s (moral) thought world and is often employed as part of his self-delineation in order to oppose his genuine ēthos to that of other, less sincere physicians-cum-philosophers. In the Therapeutic Method, for example, Galen distances himself from doctors who try to appear learned, and protests that such pretence of wisdom (what he calls δοξοσοφία, doxosophia)²¹ constitutes neglect of proper manners (ἀμελήσαντος ἤθους χρηστοῦ), or lack of high moral character:

At the present time, the vast majority try to teach others things which they themselves did not ever do or demonstrate to others. It is not surprising, then, that many doctors, being neglectful of proper manners, are more eager for the pretense of wisdom than for truth. My character is not like this. For not just yesterday or the day before, but right from when I was a young lad, gripped by a love of philosophy, did I eagerly turn to that [discipline, i.e. medicine].²²

MM 9.4, X.609.2-8 K.²³

Galen’s stance towards doxosophia is consistent throughout his writings, as is his readiness to detect it in others whom he does not like. The term occurs most frequently in the Affections and Errors of the Soul, where it is always presented as a dangerous passion to be circumvented; whereas in other works, Galen is keen to connect doxosophia to a fraudulent understanding of knowledge²⁴ or associate it with sophists whom he believes to be liars and to distort the truth.²⁵ However, the important implication emerging from the passage above is that betraying one’s devotion to truth renders one less morally authentic (less true to oneself, as it were) and can create serious moral flaws in the community, such as those outlined in the passage from Prognosis cited above. The most salient is flattery and the associated morning salutation and continuous attendance that clients were expected to give their patrons. These are indeed enduring themes, dealt with in earlier and coeval satirical works, for instance, those by Juvenal and especially Lucian.²⁶ However, in Galen these themes are embedded in a framework where practising physicians play the chief role. In addition, although Lucian laments over the stagnation in philosophy, which he sees as an evil of modern life, Galen focuses more on the decline in medical practice and the abuse of the profession by fraudsters. Therefore, in revisiting the conventional tropes found in satirists, Galen adds moral ramifications to the abuse of medicine in particular.²⁷ Just as he did in Recognising the Best Physician (Chapter 7), he attributes the distortion of truth to the group of flatterer-physicians who defraud their patients (including in relation to prognosis) in morally repugnant ways, e.g. by being charlatans, ‘doorkeepers’ and drinking companions, rather than true healers (Opt. Med. Cogn. 9, 115.18-20 I.). For that point of view, Galen’s exposition seems in essence closer to the description of the true doctor, as opposed to vulgar deceivers, in the Hippocratic On Decorum 2-4: in that case the former is committed to virtue and simplicity of manners and appearance, while the latter behave disgracefully and flamboyantly.²⁸ The same note informs the preface to the Hippocratic Prorrhetic 2, where extravagant claims made by forecasters about the outcome of the patient’s disease are dismissed by the Hippocratic author, in favour of an experiential prediction based on observation through the senses.²⁹ Veracity and authenticity, not deception, is what the Hippocratic texts recommend in the field of prognosis, with Galen following the Hippocratics’ lead in that respect.

But Galen’s protest over the lack of ability seen in doctors and other practitioners of the arts has two parts to it. This time he comes down hard on them for persuading the unsophisticated (τοὺς ἰδιώτας) that they are fashion icons and hence men of importance in society (the emphasis is on their grandiose looks, especially clothes, jewellery and retinue, Praen. 1, 68.11-14 N. = XIV.600.5-9 K.). In neutral Galenic contexts the idiōtai, unlike doctors, are simply laypeople with no professional background or experience (e.g. Opt. Sect. 9, I.123.18-124.5 K.; Opt. Sect. 26, I.181.6-12 K.). However, in Second Sophistic writings, as indeed in the Prognosis passage above, depending on context, it may function as a derogatory label for the uneducated (the ignorant laypeople) as opposed to the pepaideumenoi. That being so, the way one might be expected to persuade such men that they are important would have been through convincing them of their ability to assume cultural capital (paideia), not through their appearance. This is presumably one of Galen’s subtle shifts of emphasis in order to stress the exceedingly distorted setting in which the agents operated. I will return to this below.

On another level, the verb Galen uses to refer to the manipulation of the idiōtai as a vulnerable, easily-led social group is ἀναπείθουσιν, which can mean ‘to seduce’, ‘to mislead’,³⁰ hence pointing to the sophistic, rather than the rhetorical, overtones of the practitioners’ activity.³¹ The coaxing mechanisms employed by the manipulators in Prognosis, in fact, bring to mind the sophisms, or fallacies (σοφίσματα), that Galen dismisses in Book 2 of Affections and Errors of the Soul on Errors,³² with both groups displaying striking resemblances in terms of definition, target audience and function.

To begin with, sophisms are defined as ‘particular kinds of argument which are false, but wickedly fashioned to resemble the true ones’ (λόγοι τινὲς ὄντα ψευδεῖς μέν, εἰς ὁμοιότητα <δὲ> τῶν ἀληθῶν πεπανουργημένοι., Aff. Pecc. Dig. 3, 49.22-50.2 DB = V.72.10-12 K.). This coincides with the mismatch between appearance and reality in Prognosis, which eventually can render beguiling arguments (like sophisms) a powerful means of persuasion in the hands of impostors.³³ The ethical element in the construction of damaging arguments is captured in the participle πεπανουργημένοι, which refers to mischief on the part of the agent who devises them,³⁴ just as elsewhere these arguments rightly attract abomination (odire iustum est, CP 4, 80.18-19 Hankinson). In the same context in On Errors, Galen’s bald deconstruction of sophisms is rooted in his idea that their falsity makes it difficult for uneducated (ἀπαιδεύτοις) and unschooled (ἀγυμνάστοις) people to decipher them, just as in Prognosis it is the ἰδιῶται in particular who are easily tricked by false arguments.³⁵ Finally, in On Errors Galen claims that false beliefs arising from sophisms regarding the goal of life are universally agreed to lead to unhappiness (ἡ γὰρ περὶ τέλους δόξα ψευδὴς ὡμολόγηται πᾶσι πρὸς κακοδαιμονίαν ἄγειν, Aff. Pecc. Dig. 3, 51.5-6 DB = V.74.9-10 K.), thus depicting mistaken judgments as stimulants of moral passions, in a similar way to his overall emphasis in this theme in Prognosis, as we will now see.

Indeed, the cognitive component in the genesis of emotions is made explicit in the ensuing account in the Prognosis prologue. The author explains that the manipulators go about disfiguring reality via two routes depending on their reference group: a) they cajole (ἥδοντες) the rich and powerful in the cities by flattering them for being what they truly are, i.e. rich and powerful, or b) they impress or surprise (ἐκπλήττοντες) the unimportant ones by persuading them they are something they are not. Both the emotions of pleasure and amazement are generated because the agents ‘lack any real discrimination in these matters’ (ἀνθρώπους ἀπείρους ἀληθινῆς κρίσεως πραγμάτων, Praen. 1, 68.15-16 N. = XIV.600.10-11 K.). Again, in the background is Galen’s discussion of moral errors. At the beginning of Book 2 On Errors Galen explicates the specific sense of the term ‘error’ (ἁμάρτημα) as referring to things that happen through a mistaken decision (ἐπὶ τῶν κατὰ κρίσιν οὐκ ὀρθὴν γιγνομένων, Aff. Pecc. Dig. 1, 41.11 DB = V.59.2 K.). Later on, he connects moral errors committed in daily life not just to faulty beliefs but also to the agent’s wrongful, rash or weak assent (ψευδὴς συγκατάθεσις ἢ προπετὴς ἢ ἀσθενής), which might be suggestively related to the victims of the Prognosis, despite the accusation not being made explicit. For, the unsophisticated match Galen’s description of people who (wrongly) assent to premises (or impressions, phantasiai, as the Stoics would have called them) without really understanding them (katalēpsis) (Aff. Pecc. Dig. 1, 42.7-10 DB = V.60.3-6 K.). The victim’s yielding to impressions imposed on them by the doctors and other practitioners in Prognosis also fits Galen’s definition of weak assent as the state when ‘we have not yet convinced ourselves that a given belief is true in the same way as that we have five fingers on each hand, or that two times two equals four’ (Aff. Pecc. Dig. 1, 41.16-19 DB = V.59.7-10 K.). Interestingly, rash assent is an undesirable personal quality that Galen eradicates from his own character, once again acknowledged with aggressive hostility in response to the claims of detractors to the contrary: ‘But as in all other [situations] throughout my entire life, I have consistently refrained from rash approval’ (ὥσπερ δ’ ἐν ἅπασι τοῖς ἄλλοις καθ’ ὅλον τὸν βίον ἐμαυτὸν ἀεὶ προπετοῦς συγκαταθέσεως ἐπέσχον, Loc. Aff. 3.3, VIII.142.17-18 K.). This position had also been strongly advocated by other moralists, who said, for example, that ‘it is more philosophical to suspend judgment when the truth is obscure than to take sides’ (Plutarch, De Prim. Frig. 955C).³⁶

Through such sustained philosophical theorising on the operation and impact of the distortion of reality, Galen’s ideal audience are subtly incited to pursue a self-reflexive reading of Prognosis, actively taking sides with Galen against any dissembling affecting their moral condition: shying away from correct judgment would mean suffering moral self-condemnation.³⁷ Indeed, in On Errors false judgment and false assent are said to be so detrimental as to block recognition of good and bad, and thus what one should strive to attain or avoid (περὶ ἀγαθῶν τε καὶ κακῶν γνώσεώς τε καὶ κτήσεως καὶ φυγῆς, Aff. Pecc. Dig. 1, 42.10-15 DB = V.60.6-11 K.). Thus the ethical danger that Galen identifies when people lack moral knowledge on an abstract level in On Errors, takes on material form in the harassment and victimisation high-profile individuals and the unsophisticated suffer in Prognosis.

The most critical stage in Galen’s train of thought in the preface to Prognosis, however, is when, towards the end of the section, he transposes the accusation of wrongheaded judgment from the victims to the victimisers themselves. This he achieves through his revisionary correction (epanorthōsis) in the following cutting aside:

by cajoling or impressing men who lack any real discrimination in these matters, they gain great rewards – or so they believe: rather, I should say, they fail to win a true reward but only what they themselves wrongly assume to be so.³⁸

Praen. 1, 68.15-16 N. = XIV.600.11-601.2 K.

Galen positions himself authoritatively against the offenders by insinuating that, in deceiving others, they lose any real comprehension of the world around them. This acts as a reassurance for Galen’s audience that perplexity, in fact, affects the abusers, who are not the powerful party in a zero-sum game, but really the losers, so that the readers are in turn encouraged not to think highly of them or view their activity favourably. Again On Errors is highly relevant here. There Galen sets out the characteristics of a group of manipulators who, just like in Prognosis, deceive others as well as themselves (ἔνιοι μὲν αὑτούς, ἔνιοι δ᾽ ἄλλους αναπείθουσιν, Aff. Pecc. Dig. 3, 48.3-5 DB = V.69.11-12 K.), driven by love of reputation and love of money, inter alia. These are precisely the worldly incentives associated with the manipulations described in Prognosis, which – according to Galen’s corrective assertion – are wrongly regarded as genuine goods (οὐ τῶν ὄντως ἀγαθῶν).

Infusing the preface of a post-Classical medical work with ethical preoccupations was common practice in antiquity. In his preface to On the Composition of Medicines (epistula dedicatoria 1-11), Scribonius Largus, for example, writing around 48 AD, attributes the decline in pharmacological learning in his time to misguided morality. He refers to the lack of expert knowledge on the part of quacks and their related contriving of falsehoods, the heightened desire for monetary gain and glory, and the prevalence of envy among professionals; all conditions he contrasts (in a rather banal fashion) with the earlier reputation and honour of medicine and the proper use of medicaments. However, these are not aspects developed in a literary, rhetorical or discursive way throughout Scribonius’s treatise, but rather act as topoi of professional ethics, serving the needs of the work’s prefatory discussion. We have seen that Galen is quite original in his use of similar topoi, in that he entangles them with: a) elaborated social criticism, b) a heightened focus on theorising and defining the origins of the emotions by drawing on his philosophical exposition on moral error tackled in his ethical work and c) practical advice (direct and implied) on how to cope with them.³⁹

The proem to Book 1 of the Therapeutic Method: A complementary intertext

Even though the abuse of reality in the Prognosis preface is general enough to include both doctors and the proponents of other arts, one soon comes to realise that Galen’s intended emphasis is specifically on medicine and physicians. This becomes more obvious when he describes the ‘further enormities’ (τἆλλα παρανομεῖν) attributed to manipulators: namely that they announce that they can teach their art in a short period of time and gather many students with the aim of acquiring public influence (Praen. 1, 68.17-21 N. = XIV.600.13-17 K.). This, of course, echoes stock accusations against rhetoric and its proponents as expounded in the Protagoras, for example, which in turn resembles the heavily Platonic background of the proem. Yet, the quoted lines are better construed in the light of the proem to Book 1 of Galen’s Therapeutic Method, where many common ideas feature, particularly in connection with the moral transgressions of doctors. As I will show, the two proems may be seen as complementary pieces in Galen’s ethically-informed discussion of medicine.

In his address to the recipient of this work, Hiero, Galen protests that he had been hesitant to compose the Therapeutic Method, because in his days nobody was eager to learn the truth (μηδενὸς τῶν νῦν ἀνθρώπων … ἀλήθειαν σπουδάζοντος). Instead, what his contemporaries strove for was a series of external goods, including money, political power and pleasure, all of which in Galen’s account are presented as clouding agents’ judgment and leading them to commit moral errors. For instance, they think that there is no such thing as knowledge of divine and human matters and, similarly, they do not consider it worthwhile to pursue the arts, holding expertise in them to be sheer madness (MM 1.1, X.1.9-2.10 K.). Here we see that the philosophical explanation given in On Errors again applies, since what Galen is suggesting is that false suppositions about life goals are the source of moral mistakes.

But beyond that, it is also worth noting that the Therapeutic Method intertext is much more vociferous as to Galen’s own place in the narrative that privileges affectation over truth. In denouncing the dystopian character of contemporary life, particularly its ‘universal deceit’, by telling the truth, Galen credits himself with what is regarded as a ‘revolutionary act’, in the words of the quote introducing this Chapter. That helps explain why Galen claims to be a lone fighter: we read that he was criticised for pursuing the truth with excessive zeal (πολλάκις ἐπετίμησαν ὡς πέρα τοῦ μετρίου τὴν ἀλήθειαν σπουδάζοντι, MM 1.1, X.2.11-12 K.), and that his refusal to throw in his lot with those who told lies and their deceitful undertakings marked him out as a useless renegade in their eyes:⁴⁰

[They say] that, throughout my whole life, I shall never be of use, either to myself or to them, unless I take some time off from this pursuit of truth and go around greeting people in the early morning and dining with those who are powerful in the evening.⁴¹

MM 1.1, X.2.12-16 K.

The Roman custom of the morning salutation and dancing attendance on powerful patrons constitute the kind of behaviour that provoke the accusations Galen levels against the offenders in Prognosis, as noted above. Yet, the Therapeutic Method proem goes a step further in articulating the cultural depravation resulting from flawed morals. The marginalisation of truth and the engagement with the pleasures of the body typified by dancing, amorous adventures and bathing, inter alia, have even corrupted the genuine character of the symposium, which instead of being focused on the acculturation of its participants, now shamefully promotes intoxication and incontinence (MM 1.1, X.2.16-3.18 K.).

The failure of the convivial institution to function as it should is marked by a radical change of moral axioms and hierarchies: ‘For the best among them is not the one who plays most musical instruments or engages in philosophical arguments, but the one who quaffs the most and the biggest bowls of wine’, MM 1.1, X.3.16-18 K.⁴² This reversal of expectations is taken up by Lucian in his comic dialogue The Symposium or The Lapiths, a parody of the Platonic symposium. The narrative centres around a wedding feast, in which many highly literate men took part, including philosophers, doctors and orators. However, as the narrator Lycinus soon makes clear, these pepaideumenoi transgress moral limits by displaying the kind of social behaviour that was utterly incompatible with the standards of the education they had attained: instead of exhibiting self-control, they got drunk and overate, they were indecent and quarrelsome, and things ended up so topsy-turvy (ἀνέστραπτο οὖν τὸ πρᾶγμα) that ordinary people (the ἰδιῶται) appeared more civilised than the eggheads (Symposium, 34-35). The symposium becomes a Foucauldian ‘heterotopia of deviation’, a cultural space inhabited by individuals whose conduct is outside the norm.

Just as in Lucian’s Symposium the proper display of paideia is brutally reversed and undermined, so too in Galen the perverted version of the symposium functions as an allegory for the mishandling of the medical art, since drunkenness in particular is what Galen uses to explain the mistaken choice of doctors by the inebriated.⁴³ The latter opt not for the best physicians but for those most inclined to flattery (κολακευτικωτάτους, MM 1.1, X.3.18-4.8 K.), thus once again introducing this important error of judgment that can also be found in the Prognosis preface. Yet once again, the Therapeutic Method account is more detailed and pointed and, taken together with the Prognosis account, it gives a fuller picture of how Galen envisages the status of such doctors/flatterers: the author is blunt that this group of doctors are far from professionals, because they obey their patients like slaves (πᾶν ὑπηρετήσουσι τὸ προσταττόμενον ὥσπερ ἀνδράποδα, MM 1.1, X.4.8-9 K.). This is in stark contrast to the Asclepiadian doctors of ancient times, who according to Galen represent the genuine version of physicians, given that they had true power over their patients; they were like generals and kings (MM 1.1, X.4.9-11 K.). The distorted power dynamics between these physicians and their patients, spelled out in the Therapeutic Method and implied in the Prognosis, helps Galen emphasise the moral deviation of some physicians on account of their flattery: ‘Thus it is not the man who is better at the craft, but the man who is cleverer at flattery who is more honoured’ (MM 1.1, X.4.13-14 K.). This also ties in with the Platonic dimensions of the slavery imagery that Galen uses in Recognising the Best Physician to juxtapose the servility of impostors to his own moral independence and purity as the ideal doctor, as we have seen in Chapter 7.

It is at this point in the Therapeutic Method that Galen introduces his condemnation of Thessalus, a physician of the first century AD and thought to be the founder of the Methodic sect,⁴⁴ whom he vituperates for making a fortune overnight and acquiring many students by tactical use of flattery. The relevant reference in Therapeutic Method 1.1, X.4.16-5.3 K. resonates with the corresponding section of Prognosis 1, 68.17-21 N. = XIV.600.13-17 K. and helps flesh it out. The passage from the Therapeutic Method conjures up an opposition between the ideal(ised) classical past, in which genuine physicians struggled to perfect their art without any reliance on flattery (what he calls ‘noble rivalry’, ἀγαθὴ ἔρις), and a debased present in which ‘worthless contention’ (ἡ πονηρὰ ἔρις) dominates (MM 1.1, X.5.15-7.9 Κ.; very much like the preface to Recognising the Best Physician).⁴⁵ It is to this kind of contention, the destructive ἔρις, that Galen attributes Thessalus’s erroneous perceptions of the proper training for doctors.⁴⁶ For he opined that doctors should neither be familiar with the noble disciplines nor have any clinical experience (MM 1.1, X.5.3-9 K.). Galen considers this claim counterintuitive and ironically concludes that according to Thessalus’s way of thinking even untutored people such as cobblers, carpenters, dyers and blacksmiths could contend for pre-eminence (περὶ τῶν πρωτείων ἐρίζουσι, MM 1.1, X.5.9-12 K.) in the realm of medicine. This he finds so unacceptable that he no longer wants to write his Therapeutic Method due to vexation.

The moral decadence that existed in the field of medicine is a regular excuse for not producing works in Prognosis, where in a similar fashion Galen states that, had he known that his works would be distributed to the unworthy (ἀναξίοις), whom he specifies as being corrupt at heart (μοχθηροὶ τὴν ψυχήν), he would not have given them even to his friends.⁴⁷ This shows that Galen foresaw not just a morally-regulated medical community but also a morally-regulated audience for his works and that he paid particular attention to the ethics of reading and consumption in general. Ideally he expects his tract to be taken up for the sake of learning and not in order to viciously attack its main points (Praen. 9, 120.3-6 N. = XIV.651.1-5 K.). By the same token, he is blunt that his work will be of use only if it presumes readers who are zealous for the truth, persons of energy, enthusiasm and prudence, not pleasure-seekers, insatiable for wealth and fame or lazy wastrels (Dig. Puls. 1.1, VIII.773.6-774.5 K.). In The Order of My Own Books he declares that the real value of this work is not so much to enhance factual knowledge for readers practised in logic, but to instil correct thinking, including an ability to acknowledge proper ethical qualities when they see them (Ord. Lib. Prop. 2, 91.13-92.4 Boudon-Millot = XIX.53.10-54.4 K.). This shows that Galen’s production has a strong ethical outlook. And the programmatic prologue of On My Own Books should be interpreted in the same light. Here Galen censures colleagues in medicine and philosophy for having the nerve to lecture publicly, though they cannot even read properly. This kind of bad behaviour he calls ‘scheming’, ‘intrigue’ (ῥᾳδιουργία), thereby adding a distinctively moral inflection to his criticism (Lib. Prop. Prol. 4, 135.2-9 Boudon-Millot = XIX.9.7-13 K.). Galen’s insinuation here is not so different from the ones analysed from the prefaces to Prognosis or Therapeutic Method, in which semblance and false impressions (unlike genuine ability and truth) signify moral bankruptcy in the oral and written discourse of Galen’s world.

In resuming the topic of Thessalus’s contentious argument, Galen dwells on the fact that the latter criticises Hippocrates (mainly for his theories on the nature of man) and has shamefully proclaimed himself a champion and the winner in the contest with the father of medicine. Such misguided perceptions drove Thessalus to both foolishness and insolence (hybris) according to Galen (elsewhere Thessalus is shameless and reckless), which flags up the by now familiar pattern of a false assumption leading to moral error, but also this time to moral passion (MM 1.2, X.7.10-8.13 K.). In fact, Galen’s hostility to Thessalus culminates in a speech he levels against him, which takes the form of insults mixed with character assassination.

For a start, Galen accuses Thessalus of discrediting those things that are good (διαβάλλειν … τὰ χρηστὰ, MM 1.2, X.8.13 Κ.) in his attempt to stand out from the crowd (διὰ τὸ παρὰ τοῖς πολλοῖς εὐδοκιμεῖν, MM 1.2, X.8.14 Κ.). We have already seen that this specific phrase also occurs in the Prognosis proem,⁴⁸ where it signifies that seeking popular reputation obstructs the development of the arts, which is precisely what Galen criticises Thessalus for in the Therapeutic Method. In addition, just as in the Prognosis proem, development of the arts is intertwined with love of truth, so in the Therapeutic Method too Thessalus is attacked for neglecting to excel in things that are true, or being diligent and a lover of truth (ἐνὸν ὑπερβάλλεσθαι τοῖς ἀληθέσιν, εἰ φιλόπονός τέ τις εἴης καὶ ἀληθείας ἐραστής, MM 1.2, X.8.14-15 K.). Similar themes regarding reputation are again dealt with in Galen’s second proem to the Therapeutic Method (Book 7), this time addressed to Eugenianus, in which Galen eschews desire for popular reputation as a trait of his own character (εὐδοκιμεῖν is here replaced with δόξα, marked in bold in the passages in nn. 49–51).⁴⁹ Likewise, he considers reputation a hindrance to virtue,⁵⁰ truth and knowledge.⁵¹ Although here the text suggests that his despising of popular reputation was the result of a tendency that he had instilled in himself already in his youth, in Therapeutic Method 10.4, X.609.2-8 K. and elsewhere, Galen explicitly connects this virtue to the early education he received from his father. This is in stark contrast to Thessalus’s depravity, stemming from his vulgar father and effeminate education (unlike Galen’s hypermasculine paternal paideia).⁵²

Moreover, Galen’s moral account in the Therapeutic Method also references the dissimulation elements found in sophistic practices, much as we have seen in the Prognosis. In a separate section, Galen blames Thessalus for appointing his father’s fellow craftsmen to judge doctors, so that by this cunning ploy he can be the winner in a ‘fixed’ competition. Even though his father’s fellow craftsmen are not further described in this context, it is reasonable to argue that they are meant to represent the class of sophists for two reasons.

Firstly, they are juxtaposed a bit further on in the text to a group of ‘men of old’, whose characteristics prompt us to identify them with philosophers proper of the Socratic type. They are described as ‘men who were skilled in dialectic and capable of knowledge, who were practised in distinguishing truth and falsehood, who knew how to differentiate consequence and contradiction as they ought, and men who had given careful attention to the demonstrative method from childhood’ (MM 1.2, X.9.3-6 K.). Indeed, these are the same features Galen himself ascribes to philosophers in another passage further below (MM 1.2, X.18.2-13 K.), identifying them as the supporters of Plato, Aristotle and Chrysippus.

Secondly, these craftsmen correspond to Galen’s definition of sophists in Prognosis, in a section in which Galen states that ‘some rhetorical gentlemen’ (τινὰς τῶν ῥητορικῶν ἀνδρῶν) are engaged with demonstrative theory not for its actual philosophical merits, but only when they want to use ‘that disreputable instrument, the so-called sophistic theory’ (ὀργάνῳ πανούργῳ, τῇ σοφιστικῇ καλουμένῃ θεωρίᾳ, χρῆσθαι, Praen. 1, 74.2-6 N. = XIV.605.2-5 K.).⁵³

All in all, Galen’s description of the moral aberrancy of the medical profession in the Prognosis proem is expanded upon and made more forceful in the Therapeutic Method prologue to Book 1, where more details are given about some important issues. For example: a) the target of Galen’s attack is made more precise, taking the form of the wicked representative of medicine’s nadir, Thessalus; b) Galen’s own role in the attack is clearer and punchier, as he endorses truth and dismisses falsehood, especially its ‘disreputable instrument’, sophistry; and c) the implied condemnation of sophists in the Prognosis is given free rein in the Therapeutic Method, where it is tied up with contention (eris), its infamous guiding force.

Truth as a moral end in the context of a despair narrative

A separate section of Prognosis explicates the common ill (κοινὴ … δυστυχία) of Imperial-period society in the light of the subverted state of medicine in particular, thus refining the more general social outlook Galen seems to be presenting in the proem. The most important characteristic of the decline in medicine is the way doctors are refraining from speaking their minds and the vanity of parrhēsia on the part of the medical predictor. As the text explains, if a physician competently predicts a certain disease, he risks attracting his colleagues’ hatred and losing their respect; he is in danger of being considered a sorcerer (an offence punishable by death at the time)⁵⁴ and is generally faced with suspicion as being a monstrosity and a rarity.⁵⁵ In a debauched medical landscape of this sort free speech is under threat, since the predictor often does not dare (τολμᾶν) reveal the source of a correct prognosis (whether his own discovery or by consultation of earlier authorities) and finds himself in a predicament, debating with himself (διαβουλευόμενος) and being hesitant (Praen. 1, 68.22-70.25 N. = XIV.600.17-602.14 K.). The attribution of mental deliberation to the genuine type of physician is key, because, as we will see, this is the determining feature which sets him apart from arrivistes and wicked men normally devoid of such skills. On another level, the predictor’s rational position incites his enemies’ envy (phthonos), leading them to conspire against him using poisoning or exile.

The above reversal of moral standards in the functioning of the medical profession naturally introduces into the discussion Galen’s self-professed type of medicine, which is pursued in a philosophical manner (φιλοσόφως; see the passage cited below) and implicitly contrasted to sophistic manifestations, as analysed above. One would therefore expect to find in this new section more wholly positive scenarios exemplifying this morally-administered medicine, as in Dio of Prusa’s Orations 77/78, ch. 8–10 and 14, for example. In that case Dio candidly denounces the envy among medical professionals in a big city, considering it a mark of insanity. His main point is that the need to restore public health should override the physician’s self-centred desires for distinction, and that the amassing of personal wealth and honours has no place in a serious pursuit like medicine, where colleagues should be collaborators, not venal enemies. The distinction between usefulness and pleasure underlies other similar passages, as evinced, for instance, in Galen’s own use of the Platonic opposition between a doctor and a cook (Praen. 1, 74.8-11 N. = XIV.605.8-12 Κ.; also seen in Chapter 7),⁵⁶ which might also have facilitated a similar transition to a direct display of philosophical medicine to the one Dio makes. And yet our author does not go down this path. What he does instead is to delve into the numerous ways in which adhering to truth, showing moral integrity and generally doing one’s duty could have damaging consequences in society. The passage is worth citing in full, not least because it raises a number of ethically-loaded points of interest:

Thus, whoever wants to pursue the art of medicine in a philosophical manner worthy of the sons of Asclepius must suffer one of two things: either he can go into exile like Quintus and keep the rewards of his perception untarnished, or, leaving himself wide open to calumny, he can, if he lacks spirit, put forward a justification and then cower back, living like a hare, trembling in constant expectation of disaster – while nevertheless increasing others’ suspicions of sorcery. If he has greater courage and joins battle, fighting alone against many wicked men, well practised in many ways of crime, himself relying upon his education and learning and innocent of such evils, he will be taken by force, from then on he will be in their power, however they should wish to use him. Even if he holds out longer and continues the struggle by some remarkable luck, he cannot escape being caught up in that most dreaded of wars, internecine strife, both as attacker and attacked.⁵⁷

Praen. 1, 70.25-72.12 N. = XIV.602.14-603.12 K.

The presentation of opposing scenarios together with their accompanying results seems to have (some fairly distant) Platonic echoes here: e.g. the way Socrates in the Apology discusses the choice between going into exile or staying in Athens at risk of his life, the description in the Republic of what is likely to happen to philosophers who go back into the Cave, or Callicles’s threats in the Gorgias about what Socrates risks if he carries on with philosophy instead of switching to oratory. Yet, in this extract Galen builds up a script of despair, emphasising that in the current moral climate, whatever route the predictor chooses to follow, he is destined to fail. If he is brave enough to preserve his moral authenticity, he will have to suffer exile, otherwise if he is cowardly, he will experience fear instead. Interestingly, the word ‘fear’ is not used in the text, but only evoked through Galen’s analysis of its subjective phenomenology (an emphasis on what emotions feel like rather than on how they might be objectively defined): e.g. a) reference is made to the physical symptom of trembling and b) the emotion is depicted using the simile from the natural world ‘like a hare’. The narrative of suffering (παθεῖν) in every possible way not only encapsulates Galen’s indignation at the current situation but also arouses readers’ indignation, as they would have felt the dismay evoked in the ensuing metaphors concerning the inevitable defeat of both the attacker and the attacked in a harsh civil war.⁵⁸

It is this sense of inevitability that drives Galen’s argument. The author explains that even men with a pure regard for truth (ὅσοι τετιμήκασιν ἀλήθειαν εἰλικρινῶς, Praen. 1, 72.14 N. = XIV.603.14 K.) are doomed to hopelessness. They are described as men who appreciate truth not for its externals but for its own sake (οὐ διά τι τῶν ἔξωθεν ἀλλ’ αὐτὴν δι’ ἑαυτῆς, Praen. 1, 72.14-15 N. = XIV.603.15 K.), a formulation suggesting that for them truth translates to a moral end, just as in Aristotelian ethical theory happiness is the only end or good desired for its own sake. So, Galen contends, as soon as they experience the injustice and ‘clearly understand’ (γνῶσι σαφῶς, Praen. 1, 72.16 N. = XIV.603.16-17 K.) – another sign of their robust rational abilities, see above, pp. 18–19 – that they cannot benefit society amidst such degradation, lovers of truth will eventually retreat into philosophical isolation.

We have seen that in other moral contexts Galen does not propose withdrawal from public life to ensure peace of mind, just as he does not recommend complete elimination of emotions as a point of dogma. In this case arguing in favour of not playing one’s part in society fits the narrative of despair that emphasises the corrosive effects of wickedness, injustice and falsehood upon philosophically-minded men, who were often forced into retirement as a result of this dreadful condition. This suggestion is buttressed by the following section in the narrative, which explains that cutting oneself off from society in essence can be equated with rejecting the rabble (τοῦ τῶν πολλῶν συρφετοῦ) and popular reputation (εὐδοκιμεῖν παρὰ τοῖς πολλοῖς ἀνθρώποις) as scoundrels (τοῖς πανούργοις). Philosophically-spirited men, Galen stresses, decisively choose knowledge and the friendship of the gods as well as association with the most noble men (γνώριμοι δὲ καὶ φίλοι μάλιστα μὲν καὶ πρῶτον θεοῖς, εἶτα τῶν ἀνθρώπων τοῖς ἀρίστοις; all passages in this paragraph from Praen. 1, 72.15-21 N. = XIV.603.15-604.5 K.). This is the kind of behaviour he recommends to his colleagues and fellow citizens.

The discourse on malice

The description of the ethical quandaries faced by physicians in Rome provides the basic framework in which the case narratives that follow may be gauged from a moral standpoint. The first clinical encounter revolves around Eudemus the Peripatetic philosopher, a patient suffering from quartan fever.⁵⁹ Eudemus is a key character with remarkable cultural credentials in the text, since he is Galen’s philosophy teacher and a Pergamene intellectual immersed in Greek paideia residing at Rome.⁶⁰ What is more, he is also vital from a narratological perspective because, as we will see, by the end of chapter 4 he has been progressively redefined from being a mere patient to an agent passing on moral capital. His position in the exchanges also allows Galen the character to shift his authority according to the demands of the story, from teacher and guide, to a student who also advises and guides. Finally, Eudemus’s case facilitates the inclusion of a long section on malice, which takes the form of an embedded digression inserted just after the beginning of the second case history, that of a young man (from Praen. 2, 78.3 N. = XIV.608.18 K. onwards). In reality, even if his role as a patient actually comes to an end early on, Eudemus does not abandon his part as Galen’s philosophical interlocutor. His presence, just like that of Epigenes, extends across the narrative to enable Galen the character to communicate his moralising.

The performative facets of Galen’s prognoses (especially the amazement he excites in spectators), the praise and indeed the censure he receives from high-status officials and intellectuals, as well as any strictly medical aspects pertaining to the prognostication of illnesses have already been studied by others. However, the case histories as moral textual entities have previously gone unnoticed, in all likelihood because of their rhetorical sophistication, which prima facie makes them look like Second Sophistic vehicles for providing ‘liveliness and variety’.⁶¹ Through the various group scenes, particularly those with his medical opponents, I would argue, Galen the persona produces an intricate discourse on malice, in which he draws attention to his exonerated moral ēthos as a strategy to reinforce his medical and philosophical self-presentation while demolishing that of his attackers (cf. Chapter 3).

The starting point to that comes with the doctor Antigenes,⁶² who ridicules Galen (καταγελῶν twice, Praen. 3, 82, 13 and 17 N. = XIV.613, 13 and 17 K.) for being unable to treat Eudemus’s fevers. The Galenic narrator informs us that Antigenes was considered the physician par excellence in Rome at the time (most probably insinuating that he was not, in the light of his ensuing moral denunciation by Galen) and that he addressed both the idiōtai (laymen) and the medical experts when traducing Galen. Antigenes’s scornful attitude is summarised in the following remarks put into his mouth: ‘Look at Eudemus: he is in his sixty-third year; he has had three quartan attacks in mid-winter; and Galen promises to cure him!’ (Praen. 3, 82.20-22 N. = XIV.614.3-5 K.). That this is articulated in direct speech is most pertinent, because direct speech is as a rule used by Galen to boost his own central role, either through self-referential comments (e.g. Praen. 2, 80.7-10 N. = XIV.611.10-13 K.) or unfair attacks made on him by others, as in this case.

As a matter of fact, in this instance we have a combination of both modes, given that Antigenes’s attack on Galen is counterbalanced by Galen’s self-justification, which is apparently endorsed by Epigenes:

I know that you, my dear Epigenes, constantly trumpeted my later predictions in this case and my treatment, but here for the first time there arose jealousy because I was winning admiration for my dignified way of life as well as for my professional successes.⁶³

Praen. 3, 82.22-25 N. = XIV.614.5-9 K.

In On My Own Books Galen similarly states that, when a doctor is praised, his competitors in the same art envy him, levelling malicious attacks at him (Lib. Prop. 1, 139.17-20 Boudon-Millot = XIX.15.7-9 K.). Yet a dignified life is not mentioned as an explanation for the arousal of envy in medical professionals. In the context of the Prognosis Galen’s noble character is key to both sparking jealousy and bringing down those who succumb to it, for eventually Antigenes was brought low (κατὰ γῆς ἐδύετο), precisely because of the ruthless vilifications he had uttered against Galen (διὰ τὰς προπετῶς αὐτῷ γενομένας εἰς ἐμὲ βλασφημίας, Praen. 3, 84.1-2 N. = XIV.614.16-18 K.). Here we get Galen’s response to Antigenes’s acrimonious direct speech above, namely a self-statement of moral incorruptibility that outweighs the defamation essayed by Antigenes. As we will see with other enemies of Galen too, throughout Prognosis the author depicts them as morally unsound so as to destroy their probitas morum (‘uprightness of character’), a prime element of the physician’s public persona and regarded as a guarantor of medical prowess from Hippocrates onwards. Especially in the Roman period, epigraphic, honorific and legal sources, both in Greek and Latin, show that appraisal of a civic doctor was partly reliant on his ethical excellence,⁶⁴ and it is with this contextual parameter in mind that Galen polemicises against the ēthos of his rivals, while defending his own. The Galenic declaration ‘I was admired for the dignity of my life and for my professional successes’ (θαυμαζόμενος ὡς ἐπί τε βίου σεμνότητος καὶ τοῖς κατὰ τὴν τέχνην ἔργοις, Praen. 3, 82.24-25 N. = XIV.614.8-9 K.) makes use of formulaic expressions intertwining ēthos (mores) and technē (ars), as evidenced in inscriptions honouring doctors.⁶⁵ That also explains why Galen describes his enemies as not corresponding to the persona of the medicus gratiosus (in Deichgräber’s term),⁶⁶ the wise and learned physician that he depicts himself to be.

Character assassination is indeed at the root of Galen’s claim to moral superiority over another medical antagonist, the Erasistratean physician Martianus, who, annoyed by Eudemus’s eulogy of Galen, used to slander the latter by claiming he based his forecasts on divination, not medicine. In this case, the hostility against Galen does not take the form of mockery, as with Antigenes, but is driven by malignity, Martianus’s chief moral passion.⁶⁷ The extensive description of this passion occurs in the context of a medical encounter in which Eudemus is the patient. After Galen’s prediction that Eudemus would recover from his quartan fever, Martianus witnessed a new, more intense paroxysm of the patient, and so ‘he went off immediately with a cheerful countenance, displaying obvious pleasure at the failure’ of Galen’s prediction (ἐχωρίσθη παραχρῆμα φαιδρῷ τῷ προσώπῳ φανερῶς ἐνδεικνύμενος ἐπιχαίρειν ὡς ἀποτετευγμένης τῆς προρρήσεως, Praen. 3, 84.15-17 N. = XIV.615.16-18 K.). I will return to the specifics of the phenomenology of the passion below.

For now it should be noted that the determining aspect in the development of the story is that the patient himself, who appears intellectually demanding⁶⁸ and to some extent medically aware, as we have seen,⁶⁹ is now presented as putting a lot of confidence in Galen’s prediction (θαρρῶν ὡς οὐ σφαλησομένῳ μοι κατὰ τὴν πρόρρησιν, Praen. 3, 84.18-19 N. = XIV.616.1-2 K.), despite his initial scepticism as to the outcome of the latter’s prognosis and overall medical role.⁷⁰ For that reason, he requires the prognostication of other doctors too in order to balance the debate. Remarkably, the new group of Galenic opponents have the same malevolent characteristics as those displayed by Martianus: they too had cheered up (φαιδροτέροις γεγονόσιν), rejoicing (ἐπιχαίρειν) at the failure of ‘Galen’s’ prognostication (Praen. 3, 84.26-27 N. = XIV.616.10-12 K.).

Galen appears conversant with the philosophical specifications of malignant joy, or Schadenfreude, and employs them appropriately in his text. For example, his description of the passion accords with Aristotle’s similar account in Rhetoric 1379b17–18. Here those who experience Schadenfreude are said to ‘rejoice at misfortunes or simply keep cheerful in the midst of misfortunes’ (καὶ τοῖς ἐπιχαίρουσι ταῖς ἀτυχίαις καὶ ὅλως εὐθυμουμένοις ἐν ταῖς αὐτῶν ἀτυχίαις). Galen’s Schadenfreude especially resembles that of Chrysippus in fragment 401, line 7: ‘Malignancy is joy at the evil of one’s fellowmen’ (Ἐπιχαιρεκακία δὲ ἡδονὴ ἐπὶ τοῖς τῶν πέλας ἀτυχήμασιν) and fragment 402, apud Stobaeus Ecl. II 91, 20 Wachsmuth: ‘Malignancy is joy at another’s evil’ (ἐπιχαιρεκακία δὲ ἡδονὴ ἐπ’ ἀλλοτρίοις κακοῖς).⁷¹ The latter is used also in Plutarch’s On Curiosity 518C, where malignancy together with its counterpart, envy, are thought to spring from a ‘savage and bestial affliction, a vicious nature’, in line with Alcinous’s understanding of the passion in his Didaskalikos 32.4 as a ‘wild’ one.⁷² Nonetheless, the closest philosophical intertext to Galen’s depiction of malignity is Chrysippus’s account of ἐπιχαιρεκακία, as amplified in Plutarch’s On Stoic Self-Contradictions 1046B-C:

In one place he says that ἐπιχαιρεκακία does not exist; since no good man ever rejoiced at another’s evils … But in his Second Book of Good, having declared envy to be ‘a sorrow at other men’s good on the part of people who desire to disparage their neighbours so that they themselves may excel’, he adds the following: ‘To this is contiguous the rejoicing at other men’s harms, in people who desire to have their neighbours humbled for similar reasons’.

In his own account of this passion, Galen makes subtle use of two important elements from Chrysippus’s affective discourse on malignity: a) that this affliction does not affect refined and noble people,⁷³ suggesting that his attackers have failed to achieve this status. This is consistent with his tendency to present his opponents as an excluded community, and b) that malignant people’s motive is to bring others down in order to be seen to excel themselves, which coincides with Galen’s discussion of the antagonism among physicians and their power struggle for professional pre-eminence and popular support in securing their elite clients.

This ancient anatomy of Schadenfreude can be helpfully informed by the modern understanding of the emotion, especially the idea that the invidious joy the envious person experiences is based on the subjective opinion that the envied party ‘deserves’ the misfortune.⁷⁴ This is certainly the case with Galen’s attackers, whose prejudiced perception of Galen’s prognostic aptitude, interpreted as sorcery, is what sparks their Schadenfreude in the first place, although, of course, their view is vigorously questioned in the text by the Galenic narrator and other characters involved. This has the effect of making readers feel that the accusers’ Schadenfreude at Galen’s lack of success is likely to be ‘undeserved’, and so they are inclined to sympathise with him in line with the Aristotelian definition of compassion as an emotion aroused for the man who does not deserve his misfortune (Poetics 1453a5: ἔλεος μὲν περὶ τὸν ἀνάξιον). The pleasure felt by Galen’s rivals can be explained by the fact that the former’s failure in prognostication counts as their own direct gain, and this may be better interpreted in terms of the modern psychological research on the emotion whereby ‘[i]nvidious comparisons seem native to competitive arenas in which people struggle for scarce resources’.⁷⁵ Another modern reading of Schadenfreude with relevance to its treatment in Prognosis is that it has been recognised as a shameful emotion that ought to be suppressed in public.⁷⁶ That is surely not a course that Galen’s detractors are keen to take. For they mock him openly, exhibiting facial and other signs of their glee. This conduct eventually accentuates their shamelessness and insolence, duly expounded upon in the text.

Another decisive component in this part of the work is the revelation of the philosophical identity or proclivity of Eudemus and Martianus respectively, which is verbally signalled in the text and helps explain their behaviour towards Galen. In the concluding section in which his successful treatment comes to an end, Eudemus is for the first time called ‘the philosopher’ and said to have abandoned his usual measured (μετρίως) manner of speaking and to have shouted to everyone present that Galen was thriving despite being scoffed at (Praen. 3, 88.2-13 N. = XIV.618.16-619.10 K.). The Peripatetic philosopher’s transgression of philosophical moderation would have been judged harshly in another setting, but not so in this one, where Eudemus’s overexcitement is vindicated by its serving to deliver Galen’s accolade: the implicit moral is that, after the unjust treatment Galen had suffered from, he deserved to be comprehensively defended.

Martianus, on the other hand, represents the other side of the coin, in that he is now specified in the text as being not just a doctor but also a philosopher. This is designed to expose his unphilosophical behaviour. Even though others were delighted by Galen’s effective prognosis, considering him a public benefit to Rome, Martianus, driven by envy, could not bear to congratulate him or even greet him, which breached the basic rules of social etiquette. Not only that, but in an anecdote describing Galen’s encounter with Martianus, we are made aware of the latter’s unrelenting sarcasm with reference to Galen, which the character Eudemus himself labels as ‘ill will’ (kakonoia) (Praen. 4, 88.14-90.8 N. = XIV.619.11-620.17 K.). The above characterisations of Martianus are consonant with a similar description of him in Galen’s On My Own Books (1, 138.1-139.24 Boudon-Millot = XIX.13.7-15.15 K.),⁷⁷ where he is called ‘excessively malicious and contentious’ (βάσκανος δὲ καὶ φιλόνεικος ἱκανῶς) to the extent that he got exasperated at the public acceptance of Galen’s works on anatomy. Given the emphasis Galen puts on his own noble character in contrast to that of his rivals, it comes as no surprise that he responds to Martianus’s deprecatory philoneikia with his own distinctive philotimia, symbolising a positive kind of productive emulation.

Eudemus as Galen’s spokesman: Authority and moral wickedness

Martianus’s ill will is therefore the starting point for an extensive account put into the mouth of Eudemus, who now acts as Galen’s conduit for his moralising. Although in the medical bedside scenes of Prognosis the character Galen never loses his authoritative role as the protagonist of the story, in the moral encounter with Eudemus, he defers to him, letting him take over. Eudemus’s moral discourse takes up a good deal more space than any other interlocutor’s account on similar issues. And even though it deals with the comparison between the noble moral ambience in Pergamum as opposed to the debasement in Rome, which reflects the geographical distinction between the immoral city and the moral countryside typically found in other Imperial-period works,⁷⁸ it ends up delving specifically into the aetiology of the malice afflicting doctors at the heart of the Roman Empire. In that sense, it may well be seen as a vignette with moralising effect, intended for a specifically Roman elite audience, a piece of moral stricture specific to metropolitan identity.⁷⁹

Transformed into an experienced teacher of ethical issues (ἐκ πολλοῦ χρόνου πεπειραμένος, Praen. 4, 90.15-16 N. = XIV.621.8-9 K.), Eudemus goes on to amplify his educational account of wickedness. He views the latter not as the result of a sudden regression from good to bad character, but an aggravation of already established vice through the imitation of bad examples under the influence of perverted surroundings.⁸⁰ He insists that naturally vicious men in Rome have become even worse because they are trying to amass wealth, which prompts them to copy the vicious morals they see in others.⁸¹ It is therefore clear that in Eudemus’s (and Galen’s) mind a bad physis in association with an equally bad environment brings about moral deterioration, more or less in the same way that Galen believes that a good nature accompanied by an equally good nurture generate moral excellence.⁸² Therefore, one reason why Eudemus steps into Galen’s shoes to become a didactic model is to back up Galen’s views on virtue and vice, enhancing the reliability of his proem in Prognosis, particularly in connection with the ethical transgressions of doctors in Rome. It should be noted, however, that whereas the proem was more sociological and less vocal on the philosophical niceties of virtue and vice, through his mouthpiece Eudemus Galen now offers a glimpse of the specifications of moral concepts such as deterioration and imitation (mimēsis). Bearing that in mind, stronger emphasis, technical complementarity of ethical concepts as well as variation in the narrative must be other reasons why Galen assigns Eudemus the role of the ethical consultant.⁸³

Another interesting aspect in Eudemus’s explanation of vice is the connection he makes between knowledge (μάθησις … πανουργίας ὁδῶν, Praen. 4, 90.18 N. = XIV.621.11-12 K.) or theoretical grasp (τὴν θεωρίαν, Praen. 4, 90.26 N. = XIV.622.5 K.) of criminal activity, on the one hand, and acting this out depending on the moral environment in which agents reside, on the other. The idea is that in small, face-to-face towns every single moral deviation is easily noticed by the members of the community, and this prevents people from performing bad deeds, despite being aware of different ways of committing crimes on a theoretical level. Conversely, in Rome the fact that transgressors can easily escape detection due to the overpopulation and the anonymity of the city⁸⁴ encourages them to put their knowledge of crime into practice, especially since displays of wickedness are constantly acted out before their very eyes and so imitating them comes easily. The idea of social decency is implicit here, because the determining factor that encourages or prevents agents from committing bad deeds is the reaction of their fellow-citizens to those deeds. In other words, it is not mere knowledge of a vice that determines whether or not an agent will perform it, but rather the communal evaluation of and reaction to vice. This is also supported by the fact that, unlike the citizens of Rome, agents living in small provincial towns are not presented as being seduced by materialistic pursuits, so there is no environmental factor to provoke moral laxity. In Galen’s ethical mindset, therefore, morality is determined by a set of social values and the mechanisms the community has in place to administer and protect those values.

The concluding section of Eudemus’s account helps specify the identity of moral transgressors, who up to this point have been unnamed. By comparing them to brigands who attack people that catch them in the act of crimes, and indicating that their area of operation is the city, and their target a group of people of which Galen is also a member, Eudemus identifies these people as the physicians of Rome that Galen had described in his proem. That unanimity between Eudemus and Galen helps explain why Galen the character, in his immediate response to Eudemus, personalises the latter’s account by declaring that he wishes to leave Rome so as to get ‘all the more quickly rid of the evil of these scoundrels’ (ὥστε θᾶττον ἀπαλλαγῆναι τῆς πανουργίας τῶν μοχθηρῶν τούτων ἀνθρώπων, Praen. 4, 92.9-10 N. = XIV.623.1-2 K.). Scholars have debated the veracity of Galen’s words about abandoning Rome,⁸⁵ but what is important here is the function of this powerful statement in the moral dialogue enacted before us. Given that Eudemus’s lengthy account on Roman malice reproduces Galen’s own ethical anxieties, it makes sense for Galen the character too (though not the author anymore) to show his indignation over the downtrodden moral topography of the capital, so that his wanting to leave the city reinforces Eudemus’s perspective. In a way, this is Galen’s individual response to societal and medical vice. Galen’s literary device therefore does not necessarily constitute a violation of factuality. For other passages in his work too show that it is a recurring trait in Galen to respond to the immorality of his rivals with a redirection of personal hierarchies.⁸⁶

That Galen’s group of rival physicians in Rome overlap with Eudemus’s moral transgressors and that the latter also coincide with the physicians Galen attacks in his proem is also shown by Eudemus’s reply to Galen. Here Eudemus highlights one of the central concepts developed by Galen in the preface, namely the distortion of truth on the part of abject agents: a) Galen’s medical enemies, being liars themselves, believe that Galen is similarly lying (ὥσπερ αὐτοὶ ψεύδονται, πάντες σε νομιοῦσιν ὁμοίως αὐτοῖς ψεύδεσθαι, Praen. 4, 92.12-13 N. = XIV.623.3-5 K.); and b) they think that Galen, just like others coming to Rome, seeks to amass wealth (οὕτω καὶ τοὺς ἄλλους οἴονται παραγεγονότας εἰς αὐτὴν οὐκ ἂν ἐθελῆσαι πρὶν ἀθροίσουσιν ἀργύριον ἀπαλλαγῆναι, Praen. 4, 92.15.17 N. = XIV.623.8-10 K.); and c) even if Galen’s fellow townsmen confirm that Galen is distinguished in terms of his origin and property, other physicians would claim that these are Galen’s fabrications to deceive his audience (κατεσκευάσθαι πάντως ὑπὸ σοῦ φήσουσιν ἕνεκα τῆς τῶν ἀκουσόντων ἀπάτης, Praen. 4, 92.18-19 N. = XIV.623.11-13 K.). Galen phrases Eudemus’s reply in such a way as to stress the element of subjective, or indeed faulty, thinking on the part of the medical transgressors (in bold). This reminds readers of the mistaken views of manipulators as described by Galen in the prologue and effectively highlights their moral background, which in both cases (the manipulators and the medical transgressors) is based on ignorance (ἀπαιδεύτων, Praen. 4, 92.13 N. = XIV.623.5 K.). This is conclusive evidence that Galen the author is orchestrating the dialogue between Eudemus and Galen the character.

The Galenic narrator recounts in indirect speech some additional details of Eudemus’s reply, the most important of which is the poison plot his ignoble opponents devised to ambush skilled physicians. This prompts Galen the character to shift to direct speech and express his gratitude to Eudemus for his warning. As the section below indicates, Galen focuses on the usefulness of Eudemus’s moral didacticism:

I am grateful to you, my dear teacher, for telling me all this about their villainy. I shall take good care of myself and, now that I have joined issue with them and uncovered their ignorance, I shall leave this great and populous city for that small town where we all know one another, our parentage, our education, wealth, manners and way of life. Having come to this decision, I do not intend to expose their ignorance and villainy further.⁸⁷

Praen. 4, 92.26-33 N. = XIV.624.2-11 K.

Some points are worth discussing here. The first relates to issues of authority. By becoming a student of Eudemus in the dialogue, Galen consents to another person with significant philosophical influence taking the lead in passing on the discourse on malice. This way, the account that entails Galen the character being the main victim of villainous doctors seems less biased. Secondly, the concession of authority from Galen to Eudemus puts Galen the character in a position to think about his care of the self (ἐγὼ γὰρ ἀσφαλῶς ἐμαυτὸν φυλάξω) from the standpoint of a recipient of ethical recommendation. This bespeaks the centrality of psychic wellbeing for moral learners in Galenic ethics. And thirdly, the foundation, or perhaps the accompanying vice, of villainy is ignorance, which can be easily concealed in the anonymity of crowded cities. This lack of acquaintance, communication and social bonding engenders moral relapse, whereas familiarity with one’s neighbours allegedly eliminates it. Perhaps the two most vital parameters of familiarity among fellow citizens mentioned above are tropos and bios, the characterological and ethical features of one’s patterned lifestyle, as guarantors of one’s disposition in small towns. Such evidence of good character is harder to find in over-crowded cities, which is why, in Galen’s opinion, small towns are spaces fostering good morals.

The discourse on philoneikia

It has been argued thus far that the first case histories in Prognosis, in conjunction with the text’s prelude, build a framework in which structured moral narratives are communicated to readers, either to recommend the moral administration of the medical profession or to reflect broader ethical attitudes and the social factors conditioning them, as seen for example in the discourse on malice. As the text progresses, another ethical discourse, this time on love of strife (philoneikia), is advanced, which is again tied up with Galen’s medical role. In the Hippocratic Precepts 8, contention among doctors is a sign of weakness, and Galen most likely has this in mind in putting forward his views on quarrelsomeness. Two core features of Galen’s account on malice recur here as well: first, the presence of an advocate of Galen the character, designed to support his account, especially as regards the moral teachings delivered. In this case, it is Epigenes who takes over, replacing Eudemus. Second, the amplification of a general context of envy (phthonos) of Galen, who is increasingly attacked by his medical colleagues as his successes and reputation grow even greater (e.g. Praen. 5, 94.12-19 N. = XIV.625.7-17 K.). It is against this backdrop that the digression on strife is recounted by the Galenic narrator.

That this story is key to the overall structure and content of the work is also seen from the fact that, in addressing his recipient Epigenes, ‘Galen’ – in a metatextual fashion – explains the precise reasons behind its inclusion. On one level, he wants to provide sufficient detail through recollection (anamnēsis), so that Epigenes will be able to share the story with an audience considered ‘worthy of participation’ in this kind of discourse. This reflects the wider philosophical appeal of Galen’s account as well as his ethics of reading (see above). On another level, ‘Galen’ is also interested in giving as brief an account as possible, while preserving the whole sequence of events, considering this incident a representative example of his medical accomplishments and, more interestingly, of his response to the jealousy of doctors and philosophers (Praen. 5, 94.24-96.2 N. = XIV.626.5-14 K.). Strikingly enough, ‘Galen’ admits that he has developed an attitude of self-defence when other people threw mud at him (προπηλακιζόμενος, Praen. 5, 96.2 N. = XIV.626.14 K.) and that this attitude is something he has learned from Homer (Ὁμήρου με παιδεύσαντος, Praen. 5, 96.2 N. = XIV.626.15 K.) through the Iliadic line ‘a man should defend himself, when someone else gets angry with him first’ (ἄνδρ’ ἐπαμύνασθαι ὅτε τις προτέρως χαλεπήνῃ, Iliad 24.369, at Praen. 5, 96.4 N. = XIV.626.16 K.). This proverbial line and the message it carries are at the heart of Galen’s exposition of philoneikia, and help him unveil the moral failings of people he associates with, just like his attackers accused him on moral grounds when they claimed that he was a diviner, not a true doctor. This is a favourite move by Galen as seen in Chapter 3.

The story the Galenic narrator reports recalls an anatomical gathering in which Galen the character dissected animals to demonstrate how breath and speech worked. The participants in this session vary in terms of their philosophical affiliations (Stoic, Platonic, Aristotelian) and professional identity (physicians, philosophers, orators), but generally two opposing groups may be discerned, one personified by the Roman ex-consul Flavius Boethus (who would become governor of Syria Palestina) and the other by his student Alexander of Damascus (perhaps to be identified with the father of Alexander of Aphrodisias).⁸⁸ As we learn from On My Own Books and the beginning of Anatomical Procedures, Boethus is someone Galen admired, the addressee of some of his medical works and a practitioner of Aristotelian philosophy.⁸⁹ This description aligns well with what is said of him in Prognosis, viz. that he is a lover of elegance and learning (ἦν φιλόκαλός τε καὶ φιλομαθὴς, Praen. 5, 96.6 N. = XIV.627.1-2 K.), with his moral excellence also well suited to his role as an advocate of Galen, as evinced earlier in the text (e.g. Praen. 2, 80.25-82.2 N. = XIV.612.12-17 K.). For, in accordance with the general pattern Galen has established thus far, his supporters are uniformly cast as ethically superior agents, just like himself.⁹⁰ Both Epigenes and Eudemus fit this pattern, and they all form an inclusive community of moral insiders, so that readers, in turn, have good reason to ally with them and look up to them as ethical exemplars.⁹¹ Alexander of Damascus, on the other hand, is portrayed as an outsider, being notorious for his philoneikia, a passion which he had displayed on several occasions (Praen. 5, 96.25-27 N. = XIV.628.6-8 K.). As one would expect, Alexander soon becomes an adversary of Galen’s anatomical performance, but it is also interesting that ‘Galen’ contrives to defuse Alexander’s moral flaw in a beneficial way before it is actually acted out. In order to ensure the smooth running of what is primarily a scientific but by implication also a social act, ‘Galen’ is being proactive. Instead of excluding Alexander outright, he integrates him into the anatomical demonstration by assigning him the role of the guide (didaskalos, Praen. 5, 96.21-23 N. = XIV.628.1-3 K.) for all the participants, including Galen the character, and entrusting him with the task of drawing the logical conclusions arising from the dissections. Galen is therefore self-presented as being able to manage specific affections in practical ways, so as to preserve order in contexts in which moral limits are precarious, such as when people of varying dispositions have to interact with one another.

Despite Galen’s best efforts, however, Alexander’s affection is not contained. His philoneikia manifests itself in interrupting Galen before he completes the demonstration and interjecting an epistemological objection that contradicts Galen’s views on the reliability of the bodily senses. This provokes Galen the persona to storm off in disappointment (Praen. 5, 98.4-8 N. = XIV.628.13-18 K.). Maud Gleason has rightly assessed Galen’s ‘abrupt departure as a power move in disputation’,⁹² which is what I would suggest concerning his silence, another authoritative response to patients on other occasions, a sort of ‘passive aggression’ (e.g. Praen. 2, 76.2 N. = XIV.606.18-607.1 K.).⁹³ Galen opts for self-exclusion in order to signal his ethical separation from courses of action or behaviour he does not approve of.⁹⁴ The same holds true in this case, where his self-contained departure distances him from Alexander’s non-remedied contentiousness.

Finally, Galen’s withdrawal and his rejection of Alexander’s passion aligns him with the other participants, who had initially supported Galen’s exhortation to embrace Alexander (Praen. 5, 96.23-25 N. = XIV.628.3-6 K.) and who are now similarly disappointed by the latter’s bad manners. Their response to the passion was strategically more robust and aggressive than Galen’s own, in that they condemned (κατέγνωσαν) and censured Alexander severely (ἐπιτιμῆσαι σφοδρῶς), driven, as the Galenic narrator clarifies, by the fact that they had always been ill-disposed to his quarrelsomeness (ἐχθρῶς ἀεὶ διακείμενοι πρὸς τὴν φιλονεικίαν αὐτοῦ, Praen. 5, 98.9-11 N. = XIV.629.1-4 K.). We have here what is known as ‘characterisation by reaction’ in moralising narratives, namely character assessment focalised through witnesses or marginal characters who function as mouthpieces for the author.⁹⁵ In this case, among the assessors involved we find individuals of social preeminence such as Adrian of Tyre (Imperial chair of rhetoric at Athens) and Demetrius of Alexandria (student of the famous orator Favorinus) who are cast as ‘prudent’ enough to remonstrate with Alexander about his passion (Praen. 5, 98.9-16 N. = XIV.629.1-10 K.).⁹⁶ Readers have good reason to side with Galen and those socially and ethically elevated figures who took his part.

This anatomical episode finishes with ‘Galen’ a) having Boethus requesting his hypommēmata on the results of his dissection and b) inviting Epigenes to confirm that no one has contradicted the outcome of his demonstration fifteen years later. This suggests that Alexander represents another one of the usual obstacles to Galen’s successful career that is destined to fail. Nonetheless, I hope to have shown that the moral implications of Alexander’s passion are central to Galen’s self-affirmation as medical professional and philosopher, and his suggested management of moral passions in the context of scientific and social relations. The antagonism and polemics in this medical encounter, just as elsewhere, are not just fashionable rhetorical means for highlighting Galen’s medical proficiency. They are significant mechanisms of moral intent and effect, which Galen exploits to provide ethical advice and negotiate key moral concepts or concerns.

The same can be said, to some extent, about the case history of Sextus,⁹⁷ whose philoneikia again plays a prominent role in the story, albeit this time in a purely therapeutic setting. For unlike Alexander of Damascus, Sextus is now Galen’s patient, whose extreme contentiousness (φιλόνεικος ὢν ἐσχάτως ὁ Ἕξστος, Praen. 10, 120.29 N. = XIV.652.15 K.) is explained in terms of his being so obstinately determined to prove Galen’s prediction wrong that he refused to admit to have experienced a relapse. This leads him to disobey Galen’s therapeutic advice and to arrogantly boast of having ‘defeated’ Galen’s prediction (ἐκαυχήσατο κατ’ αὐτὴν νενικηκέναι μου τὴν πρόρρησιν, Praen. 10, 122.4-5 N. = XIV.653.2-3 K.). Here Galen does not take any measures to combat Sextus’s moral shortcomings, as he did with Alexander, because the medical encounter, unlike the social or anatomical one we have seen above, had more pressing consequences, since the disobedient patient eventually had to come to his senses as his disease worsened. Still, the Galenic narrator capitalises on the ethically related opportunities that the patient’s obstinacy presents to divulge a more generalised view of the situation. He thus extracts the axiom that ‘what a man wants, he always thinks will happen’ (Praen. 10, 122.24-25 N. = XIV.654.7-8 K.), which summarises Galen’s (negative) evaluation of Sextus’s hasty compromise and especially the way he readily believed in the imminent abatement of his illness. The quasi-proverbial saying cited above is meant to question contentiousness as a moral pathway in medical praxis and suggestively dissuade readers from embracing it as a broader social attitude.⁹⁸ Obstinacy is pernicious both for the body and the soul.

The same Galenic technique is in evidence in a case history of a young man suffering from fever in the Therapeutic Method, 11.3, X.671.6-678.18 K. As with Sextus above, the youth jeopardised his physical health due to his contentious nature, but interestingly the Galenic narrator informs us that the same philoneikia afflicted the group of doctors tending the sick, who were also ignorant and stupid, since they provided the patient with erroneous cures. So, in a way, this passage combines the philoneikia of the patient and of the medical peers as obstacles to Galen’s therapeutic role. The story is rounded off with a moral lesson arising from the patient’s character flaw, which is also related to Galen’s didactic role: ‘This patient taught many of those who were only half bad and not complete asses (οὗτος ὁ ἄρρωστος ἐπαίδευσε πολλοὺς τῶν ἡμιμοχθήρων τε καὶ μὴ παντάπασιν ὄνων) that it is sometimes necessary to nourish before the paroxysm … And I taught you (ἐδίδαξα δέ σε) that such people need to be nourished at the actual onset of the first paroxysm …’ (MM 11.3, 678.11-18 K.). In Galen’s mind, medical education is not unaffected by moral behaviour and the management of character, whether of the patient or the medical professionals.

The sociological theory of Peter Berger and Thomas Luckmann helps make sense of the function of philoneikia (alongside its associated negative eris) and kakoētheia in the medical narratives of Prognosis. Contending that individuals or social groups work together to construct objects (‘artefacts’) that have a shared meaning for them, the two theorists have argued that knowledge is the prime example of such a constructed object.⁹⁹ I hope to have shown that morality and moral knowledge form another such artefact in Prognosis, functioning as a culturally constructed ‘habitus’ for medical practice. The above passions valorise truth and ethical propriety for Galen (the author, character and narrator) and his intratextual allies, who together form a social network that favours a virtuous type of medicine, unlike Galen’s opponents who do not respond philosophically during the various operations and enactments of medicine. The most illuminating instantiation of (self-)displayed morality as habitus for medicine in the text is perhaps the praise directed by the emperor Marcus Aurelius at Galen the persona towards the end of the work. Here the ideal physician (embodied in Galen) is endowed with moral liberty (ἐλεύθερον), since he rises above other medical professionals or patients who are avaricious, quarrelsome, proud, jealous and spiteful (οὐ μόνον φιλοχρημάτων ἀλλὰ καὶ φιλονείκων καὶ φιλοδόξων καὶ φθονερῶν καὶ κακοήθων, Praen. 11, 128.25-30 N. = XIV.660.9-14 K.). Liberty is indeed a major trait of the morality of medicine, for elsewhere Galen considers it endemic to truth (Plen. 2, 32.4-5 Otte = VII.522.1-2 K.) and to imperturbability from affections (Aff. Pecc. Dig. 3, 6.26-7.1 DB = V.7.10-11 K.). Interestingly, the salience of liberty in Marcus Aurelius’s Meditations aligns with its treatment in Galen, in that it describes both disdain for deceit and freedom from passions as part of the moral make-up of the Stoic sage (Med. 4.49, 5.5; 6.16, 8.48 respectively).

Conclusion

What is the main aim behind the composition of Prognosis, then, and how does ethics fit in with this aim, according to the analysis of this Chapter? Previous studies have stressed the apologetic intention of the work, associating it with Galen’s attempts to protect his reputation against attackers who accused him of being a logiatros, a physician only in words, prioritising book learning over practical know-how.¹⁰⁰ Self-characterisation is therefore a vital means to that end, which has led Nutton to also emphasise that Galen’s superiority in virtue, as presented in Prognosis, was a fit way to enhance his value as a doctor in line with the Hippocratic Prognostic, especially at a moment when his position at the Imperial court was precarious.¹⁰¹ Nevertheless, the sophisticated moral discourse that permeates the text has other implications too, as I have shown:

1. 1. The focused discussions on excellence and vice, although expounded in the context of professional self-advertisement, become an integral part of Galen’s contribution to contemporary moral philosophy. We have seen that there is a strong theoretical connection between this ostensibly medical tract and the discussion of moral errors, as negotiated by Galen in his ethical works. Although the latter postdate Prognosis by more than fourteen years,¹⁰² the common notions and elements they share point to what we could call Galen’s mental geography, a reservoir of ideas inhabiting his mind and employed as and when appropriate, irrespective of the precise chronology of the works concerned.¹⁰³ For example, Galen’s suggestions on embracing truth and avoiding materialism or contention in Prognosis all feature in his deontological advice in The Best Doctor is Also a Philosopher, in which a physician can measure up to Hippocrates only when exhibiting these three virtues in combination.¹⁰⁴ This is an indication that ethics is a systematised, structured unit of Galen’s production, amplified not only in self-independent treatises on moral philosophy, but also spread throughout other works of a different character. Ethics infiltrates particularly the mechanisms that underlay medical forethought as a key theme of Galen’s thought and work. Consequently, even though Susan Mattern has recognised three ways of demonstrating superiority in prognosticating settings, namely ‘the physical act of curing the patient, the mainly intellectual process of identifying the patient’s problem and predicting the course of the disease …, and the mainly verbal activity of sophistic debate and persuasion’,¹⁰⁵ the moralising agenda running through Prognosis is also contrived to assert our physician’s pre-eminence. We have also noted that ethics is used as an analogy for better elucidating the malfunction of medicine. Galen seems to be tapping into the illustrative capacity of ethics in other areas too, for example linguistics, where the philosophical baggage of virtue and vice, means and end, are employed to make more meaningful the correct use of language (Soph. 2, 82.5-22 Schiaparelli = XIV.586.2-587.1 K.; Subf. Emp. 7, 63.10-15 Deichgräber).¹⁰⁶

2. 2. The moral capital of Prognosis symbolises Galen’s focused didacticism mainly through the medium of the case history. Affected Places or Therapeutic Method are other Galenic collections saturated with clinical stories, but any references to flaws of character (quarrelsomeness, anxiety, irascibility, unwillingness to obey, trickery) or imperfections of lifestyle (love of luxury, laziness, gluttony) do not carry any special moral weight in the medical snippets, which are restricted to illuminating the patient’s constitution and temperament for diagnostic, nosological or therapeutic purposes.¹⁰⁷ Nor does Galen expound such moral failings to explore and disseminate his practical ethics, as he does in Prognosis. Unlike the impersonal Hippocratic reports, the case histories in Galen are recounted by the Galenic narrator, who, as we have seen, plays a vital role in the elucidation of ethics, showing that corporeal therapy is to a large extent bound up with morals.

   Comparison with other (near-)contemporary authors is also instructive. Simon Swain has demonstrated that, in some of his cases involving melancholy, Rufus of Ephesus (two generations before Galen) reforms his patients’ social eating habits through dietetic instruction that adjusts their moral behaviour. For example, by urging them against overeating, Rufus’s ‘contemporaries would have read’ the text ‘from a moral perspective’, for instance by abhorring self-indulgence.¹⁰⁸ Parallels from Plutarch’s Precepts of Health Care and even Galen’s own Matters of Health are adduced to substantiate Swain’s claims about the social pressures the Imperial elite confronted and which often threatened their physical and mental wellbeing. Yet the moral inferences in Rufus’s case histories have none of the moral niceties found in the histories in Galen’s Prognosis, where medicine overlaps with virtue itself, as we have observed.

   Indeed, by being an advocate of suggested ethical prescription and at the same time dramatising dissenting moral approaches through personae such as Alexander of Damascus, Martianus or Sextus, Galen captures the full range of Foucault’s definition of morality, as explained in the second volume of his History of Sexuality:

   By ‘morality’, one means a set of values and rules of action that are recommended to individuals through the intermediary of various prescriptive agencies … we can call this prescriptive ensemble a ‘moral code’. But ‘morality’ also refers to the real behaviour of individuals in relation to the rules and values that are recommended to them: the word thus designates the manner in which they comply more or less fully with a standard of conduct, the manner in which they obey or resist an interdiction or a prescription; the manner in which they respect or disregard a set of values.¹⁰⁹

3. 3. In turn, moral prescription and real-time behavioural response to that prescription offers useful insights into the anticipated role of Galen’s implied or ideal audience. In reading Prognosis readers are expected to critically absorb the moral principles proposed in the text as part of their consolidated philosophical education. When it comes to Galen’s ethical enterprise in Prognosis, it is remarkable that even though there is some direct protreptic moralism, as a general rule the author does not provide ready-made solutions, being keener to problematise moral notions, thereby prompting readers to explore them in ways that would help them hone their philosophical skills, especially independent thinking. For instance, when encountering the contentiousness of Alexander of Damascus in the context of an imagined social gathering, readers are led to morally distance themselves from it through the manoeuvres Galen employs, as explained above, e.g. disdain of negative exemplars. At the same time the philosophical messages or overtones of the passion, whether hinted at or clearly elaborated in the narrative, stimulate the readers’ capacity for decoding and assessing the situation for future purposes, thus helping them adopt an appropriate moral stance in their own life while anticipating its implementation in the lives of others around them as well. The same is true of the theoretical discussion of moral errors that underlies the preface of Prognosis, which also supports the ordering and application of an advocated morality within Galen’s society. In that sense, the various moral texts or subtexts in Prognosis, despite differences in topic, style or mode of exposition, are in fact united by what Jason König has called with reference to Imperial-period miscellanies an ‘underlying ideological coherence’, a seemingly diverse set of material which is unified ‘through being imbued with distinctive ways of viewing the world’. One such view ‘reveal[s] the unseen effects of particular ethical priorities’, which completely resonates with the coherent moralising vision that Galen advances in this work.¹¹⁰