Chapter 2 - Practical Ethics in Technical Accounts

Summary

This Chapter discusses some of Galen’s technical works, especially those dealing with physiological psychology to show that Galen’s resourceful combination of popular philosophy and medicine is intended to promote mental alertness in his readers in various aspects of their personal and social lives, such as the symposium or the area of maintaining good health (hygiene). The control of emotions and the social embeddedness of ethics that Galen emphasises in these passages while at the same time describing the physical basis of character formation, make him stand out from other medical authors inasmuch as they reveal his proposed vision of a moral form of medicine.

The previous Chapter argued that Galen recasts traditional morality by introducing fresh interpretative lenses through which ethical matters may be viewed. We have seen that our author finds further opportunities for asserting the standard truths, and his own ways of challenging reflection on them, mainly through a process of defamiliarising his audience. Readers are made to take a step back, ruminate, perhaps wonder for a moment before subscribing to any moral attitude, however familiar to them it might be. They are also encouraged to extrapolate the moral gist of the various ethical narratives and thinking about how it can be appropriated to their everyday experience. There is an even greater presumption of this moral discrimination on the part of Galen’s audience in a group of technical discussions, which are to some extent also concerned with popular ethics, providing Galen with the opportunity for occasional bouts of moralising. As we shall see, in this case Galen is keen to interconnect the moral with the medical by attributing a strong ethical dimension to bodily care.

The Capacities of the Soul Depend on the Mixtures of the Body (henceforth The Capacities of the Soul) is an informative example of this sort. This speculative treatise tackles the thesis that alterations in bodily mixture (krasis)¹ due to food, drink or daily habits produce corresponding psychological effects, for example an increase in hot mixture makes people quick-tempered (διὰ γοῦν τὴν θερμὴν κρᾶσιν <οἱ> ὀξύθυμοι γινόμενοι, QAM 11, 88.3-4 Ba. = IV.821.6-7 K.). In putting forward such a physiological explanation of moral behaviour, Galen draws on the notion of the interdependence of body and soul which had become prevalent in learned philosophical and medical discourse by his time.² And he develops a model of moral psychology that departs from the one found in his ethical works, for instance in Affections and Errors of the Soul or Character Traits. Here his philosophical leanings go back to Plato’s celebrated tripartition of the soul: i.e. the idea that the human psyche is divided into three parts or faculties, the rational or ruling part (logistikon or hēgemonikon), administering thought, memory and imagination, inter alia; the spirited (thymoeides), sharing in courage and anger; and the appetitive or desiderative (epithymētikon), related to nutrition and desires.³ Internal harmony comes about when the rational part, assisted by the spirited, prevails over the appetitive, and that is achieved in practical terms by empowering the intellect through rational reflection and habituation. In this model, the body’s underlying correlates seem irrelevant to the development or therapy of the soul,⁴ as is medicine’s usefulness as a contributing science.

By contrast, the conception of the soul we find in The Capacities of the Soul, which is also at the heart of On Mixtures and to some extent On Habits,⁵ differs in that it gives much more prominence to the corporeal nature of the soul, and therefore to the medical aspect of moral therapy. It thus captures the essence of a lost Galenic work entitled Whether Physiology Is Useful for Moral Philosophy (εἰ ἡ φυσιολογία χρήσιμος εἰς τὴν ἠθικὴν φιλοσοφίαν),⁶ with Galen’s answer to that question surely being in the affirmative.

Now, Galen’s endorsement of naturalistic psychology (unlike his philosophical psychology, which is indebted to Platonic tripartition) seems, on the face of it, to exclude the power of reason and persuasion, since a person is teleologically defined by the substances of the body.⁷ In that view the self-governed moral agent of the ethical works, who enjoys ample access to education and philosophy as a way of improving his moral condition, is eclipsed by the essentially helpless embodied entity of the physicalist works, whose ‘nature outweighs nurture’, as Jim Hankinson put it.⁸ As I will go on to show, this surface reading needs to be questioned, first because, apart from the body’s biological make-up (which is connate and hence external to the agent),⁹ there is also its environment, which people can regulate by exercising voluntary action.¹⁰ Secondly, and most importantly for current purposes, because in his physicalist accounts Galen presents the agents’ administration of bodily parameters aimed at their intellectual and ethical amelioration as being inextricably entangled with a discriminating application of moral advice.¹¹ Galen thus preserves the concept of their free will as psychological and moral subjects. His support of personal accountability is also in tune with his philosophical opinion that reasoned choice (prohairesis) informs people’s actions and the consequences thereof (more on this in Chapters 4 and 5), and that virtue is a deliberative state involving acts of will,¹² not a passive condition. Imperial-era intellectual culture uniformly favoured personal liability anyway,¹³ confirming the general assumption that character in the ancient world was shaped by independent agents, responsive to the moral climate in which they lived.¹⁴

A first striking example of the way Galen can blend moral persuasion with physiological analysis is provided by what he has to say about the effects of wine and drunkenness. Specifically, the theoretical discussion of The Capacities of the Soul progressively advances to the point at which the build-up of each one of the four humours (blood, phlegm, black bile, yellow bile)¹⁵ is said to cause a shift in someone’s mental trajectory, and eventually mentions the drinking of mōrion (a type of mandragora), which produces stupefaction, and the drinking of wine, which eliminates distress (QAM 3, 18.9-19.2 Ba. = IV.776.17-777.8 K.). Galen seeks to emphasise specifically the physiological outcomes of moderate wine-drinking, which, as he explains, makes the soul gentler and braver, while also fostering bodily processes such as digestion, distribution, blood-production and nutrition (QAM 3, 21.1-6 Ba. = IV.778.15-779.3 K.).¹⁶

Nonetheless, one soon realises that the notion of moderation is developed outside its psychosomatic ambit, being dealt with as a moral virtue against the backdrop of convivial drinking, an important institution for upper-class citizens in the Roman Εmpire. As his choice of vocabulary makes clear, Galen plays on his audience’s daily acquaintance with wine,¹⁷ recognising that this is a key cultural shibboleth in the imagination of the elite. He therefore goes on to offer guidance on how to behave with as much propriety at the symposium as elsewhere. By means of four popular quotations, three from the Odyssey and one from the lyric poet Theognis, he enumerates the benefits of temperate consumption of wine, especially relief from bad thoughts and tormenting feelings, as well as its downsides when the drunkenness goes beyond respectable limits, such as incurring ridicule in public for making laughable gestures or uttering obscenities.¹⁸ Galen cautions particularly against conduct that could jeopardise someone’s harmonious co-existence with their fellow-men, as seen in a similar passage in Matters of Health, where excessive consumption of wine elicits irascibility, insolence and lewdness, all critical vices leading to desocialisation (San. Tu. 1.11, 26.4-7 Ko. = VI.55.2-4 K.).¹⁹ That Galen’s advice here is addressed to a non-specialist readership is also supported by his heavy reliance on quotations, which as Vivian Nutton rightly observes, is a move that anticipates a wider readership among the nobility.²⁰

Galen, consequently, promotes the philosophical associations of wine and is aligning himself specifically with aristocratic concepts of restraint. In doing so, he seems surprisingly sensitive to the social interface of drinking rather than its therapeutic potential or pathogenic outcomes.²¹ That is a novel approach, in the sense that in this text Galen is by and large writing from the standpoint of a physician, whose standard duties in the area of regimen included the preservation or restoration of the balanced constitution through prescriptions for diet, physical activity and drugs, and not moral guidance on affability or social integration.²² For example, the doctor Soranus of Ephesus, though acknowledging the close links between bodily and moral health, was against the idea that physicians should ‘break with custom and philosophise’ in treating the body.²³ And along similar lines, the philosopher Seneca was equally adamant that regimen belonged to the doctor’s area of expertise, and that it was within his competence to give advice about the use of wine in particular: ‘He [i.e. the doctor] will prescribe a diet, with wine as a tonic, and he will tell you when you ought to stop drinking wine so that it will not provoke or irritate coughing’ (Seneca, Letter 78.5).

Galen departs from such views. As we will see in more detail in later Chapters (esp. Chapter 6, 7 and 8), Galen has a wider concept of medicine, which he envisaged as closely intertwined with ethical philosophy, and this leads him to infuse his naturalistic accounts with moral layers, showing special concern for many strands of social and cultural life. Within the context of The Capacities of the Soul, our author assigns himself an innovative role by contemporary standards, that of an expert in shaping characters specifically by means of bodily nourishment:

So, then, let those who are unhappy with the notion that nourishment has the power to make some more self-controlled, some more undisciplined, some more restrained, some more unrestrained, as well as brave, timid, gentle, quarrelsome and argumentative – let them even at this stage get a grip on themselves and come to me to learn what they should eat and drink. They will derive the greatest benefit with regard to the philosophy related to their characters …²⁴

QAM 9, 66.11-67.4 Ba. = IV.807.17-808.6 K.

In this section of the work, Galen is addressing a group of contemporary Platonist philosophers who rejected foodstuffs as a moral determinant (and generally downplayed the physical basis of character), establishing a forceful portrayal of himself as teaching them how to adjust character.²⁵ His authority is particularly clear from the use of the expression ἡκέτωσαν πρός με μαθησόμενοι (‘let them come to me to learn’), which is a statement of authority used in other parts of Galen’s writings (e.g. PHP 2.4, 122.27-31 DL = V.234.11-15 K.). His teaching material includes not purely advice on nutrition but also, as he says subsequently, on drink, winds, mixtures of the ambient air and topography.²⁶ These are all qualifications provided by Galen so as to help philosophers achieve character improvement, in line with Plato’s numerous accounts of this process (QAM 9, 67.8-11 Ba. = IV.808.9-12 K.). The oppositional construction of this passage is reinforced in the next section, in which Galen, in his usual way, sides with Plato and censures the above-mentioned philosophers not only for failing to understand or recall Plato’s views in this respect but for also being reluctant to do so (QAM 10, 67.12-15 Ba. = IV.808.13-15 K.). This characterisation of them accentuates their lack of self-control or unsoundness of mind (sōphronein) in failing to become Galen’s students, as stressed in the passage above.

In the text that follows this passage, Galen taps into the authority of Plato and refers anew to the issue of wine drinking, citing two quotations from the Laws.²⁷ These exhort the reader to consume wine only in moderation in young age, while stressing wine’s usefulness in old age, totally repudiating drunkenness and excess. Even though the Galenic text explains the implications of wine for the body,²⁸ what the Platonic citations help emphasise is the need to regulate the use of wine on different military, social and political occasions (e.g. on a tour of duty, while being a magistrate, helmsman or active juror) as well as in private life (e.g. sexual intercourse at night). Similarly, when he goes on to briefly explicate the content of Plato’s quotations, it is the moral effects of wine that Galen develops first:

I would ask you, then, to answer this question. Does not wine, when drunk, command the soul, like some tyrant, to abandon its previous accuracy in intellectual activity and the previously correct performance of its actions; and is it not for that reason that Plato tells us to guard against it as an enemy? For if once it reaches the inside of the body, it prevents the helmsman from handling the rudder of the ship as he should and the soldiers from behaving with self-control within their ranks; it causes jurors to blunder when they should be just, and all the officials to err in their rulings, and give commands which are utterly harmful.²⁹

QAM 10, 73.4-15 Ba. = IV.811.15-812.6 K.

This passage invites a moral understanding of wine. What Galen really wants to examine is the moral behaviour of potential drinkers, from a ship’s captain to a soldier or a juror – all entrusted with public duties in both Plato’s and Galen’s society. In The Capacities of the Soul, wine is not only negotiated as a nurturing element, but is also explored in association with its ethical usefulness, as actually influencing certain qualities in one’s character, in a practical way in different areas of life, and not vaguely as in the previous passage (i.e. QAM 9, 66.11-67.4 Ba. = IV.807.17-808.6 K.). Galen advances this argument based on the writings of Plato. That explains why he concludes this section by quoting a passage from the Timaeus³⁰ that sets ‘nurture’ (τροφή, used here in its stricter sense of nourishment) alongside ‘practices’ and ‘studies’ as ‘factors destructive of vice and productive of virtue’ (ὥσπερ γὰρ ἐπιτηδεύματα καὶ μαθήματα κακίας μὲν ἀναιρετικά, γεννητικὰ δὲ ἀρετῆς ἐστιν, οὕτω καὶ ἡ τροφή, QAM 10, 75.5-7 Ba. = IV.813.4-6 K.).³¹ This is how the passage from Thrasybulus discussed earlier also works, bearing out its author’s ‘desire to derive a morality of food consumption from its medical consequences’.³² Of course, in Galen’s ethical and other moralising works there is hardly any mention of food or drink affecting moral dispositions specifically through changes in the body’s physiology, though there is an emphasis on philosophical control in the consumption of food and drink, which is intended to alert the reader to the consequences and advocate appropriate behaviour. Chapters 6 and 8 will have more to say on that.

All in all, Galen’s engagement with ethics in The Capacities of the Soul might be interpreted in the light of the distinction he makes in Art of Medicine between innate ethical characteristics determined by bodily temperament,³³ and acquired ethical characteristics formulated under the influence of philosophy (Ars Med. 11, 309.3-7 Boudon-Millot = I.336.16-337.2 K.). In The Capacities of the Soul Galen offers a combined agenda for paying heed to both categories of moral traits. The latter through the philosophical caveats about wine in social surroundings, which are meant to educate the reader in exercising self-control. The former through the proposal that wine drinking in moderation produces good mixture and hence virtue in the soul. In this case, the moderate approach to drinking that has been engrained in a moral life may eventually overcome the impact of inherent krasis, making nature an acquired state (φύσιν ἐπίκτητον ἐργάζεται, Hipp. Aph. II 40, XVIIB.554.5 Κ.), as Galen asserts in another work with reference to the role of customary practices in maintaining a healthy body.³⁴

It has been suggested that in The Capacities of the Soul Galen advertises a form of medicine whose primary role is to promote moral excellence,³⁵ and that through its polemical tone the work is meant to raise the standing of Galen’s medical expertise in accounts of the soul.³⁶ The analysis given above and elsewhere in this book shows that moral philosophy in Galen is not in competition with or ancillary to his medicine,³⁷ but more of a complementary area, a collaborative science, as we shall observe in the example from Matters of Health discussed below. This suggestion is backed up by Galen’s emphatic assertion that his argument in The Capacities of the Soul ‘is not destructive of the fine teachings of philosophy’ (QAM 11, 77.5-6 Ba. = IV.814.8-9 K.), a locution that indicates acceptance and collaboration between distinct disciplines much more than dismissal and antagonism.

By the same token, the ethical narratives we have seen so far do not merely emphasise the patient’s moral responsibility in opting for a healthy lifestyle, as others have suggested.³⁸ They mostly advertise Galen’s moralising agenda for his fellow-men, whom he deemed thinking moral entities rather than simply prospective patients qua embodied creatures. Even though several doctors, such as Aretaeus, Rufus of Ephesus, Soranus or Athenaus of Attalia, had accepted that disease-engendering customs and behaviours were related to moral choices, practices and obligations, Galen is different in that: a) he brings the soul much more prominently into his concept of health and disease and b) he links the advice he gives on moral health in his naturalistic discussions to wider societal and ethical concerns to make it resonate with the popular philosophical tradition on corresponding issues. Hence, by vigorously shoring up the role of practical ethics in the traditional domain of medicine, Galen is playing a double game as physician-cum-ethicist. His originality by comparison with other physicians in combining popular philosophy and medicine is apparent in terms of extent (an unparalleled number of references to and insinuations concerning morals), emphasis (the soul and morality/ethics not playing second fiddle to the body and medicine) and being wider in scope (his practical ethics go hand in hand with the medical art, given that Galen can take a moralising turn on just about any piece of medical analysis or advice). These aspects loom large in Matters of Health too.

This work focuses on hygiene, the art of keeping one’s body in good health. Galen’s target audience here comprises a well-off, educated group of readers, who are advised on how to follow a healthy lifestyle not in a vacuum, but within the urban environment they live in, and in the face of the socio-political difficulties and pressures they are likely to experience. In light of this, ethics could not have been left out of the account on hygiene, given the way it is socially embedded in Galen’s thinking, as seen in the previous part of this Chapter. One of the chief obstacles to health that Galen emphasises throughout is a lack of self-control, which prevents patients from monitoring their desires, leading them into bad habits that disturb their natural constitution.³⁹

The beginning of Book 5 of Matters of Health is a good test-case for the creative involvement of incontinence as a moral vice within a health-related matrix. In distancing himself from other doctors and gymnasts who had concerned themselves with hygiene, Galen highlights the efficacy of his preventive medicine as opposed to the lack of success of his rivals’ versions, accusing them in particular of being unable even to preserve their own health, despite what they preach orally or in their writings. One reason for this failure is, according to Galen, their lack of self-control (akolasia), which he links to social ridicule aimed at them, evinced in the adage ‘the doctor to others is himself full of ulcers’ (Euripides, fragm. 1086; Kannicht, TrGF vol. 5, p. 1012, in San. Tu. 5.1, 136.7 Ko. = VI.307.16 K.).⁴⁰ The other reason for their failure is overwork. True, elite ethics requires leisure time, but Galen dismisses the excuse that they lack this, by pointing to his own demanding and often physically testing lifestyle and claiming that it has not led him into similar intemperance.⁴¹ Nor, he says, has it precluded the nurturing of other virtues, among which Galen particularly stresses his love of learning and (albeit obliquely) his love of the beautiful and of labour.

Having established his professional and moral superiority, Galen repeatedly emphasises the disgrace involved in his colleagues’ erroneous attitudes to health, in order to highlight their moral failings:

How then is it not shameful for someone gifted with the best nature to be carried around by others due to gout, or to be undone by the pains of stone, or pains in the colon, or to have an ulcer in the bladder from a disorder of his humours? How is it not shameful for someone to be unable to use his own hands due to severe arthritis and to need someone else to bring his food to his mouth or wash his fundament after defecation? If he were not altogether a coward, it would be a thousand times better for him to choose to die before enduring such a life. Even if someone actually overlooks his own shame due to shamelessness and faintheartedness, at all events he should not overlook the sufferings he has day and night, as he is tormented by his passions as if by executioners. And it is intemperance or ignorance or both that must inevitably bear the blame for all these things. Now may not be the time to correct intemperance, but I do hope to cure the ignorance of those things that must be done, establishing through this treatise a healthy regimen for each specific bodily nature.⁴²

San. Tu. 5.1, 137.26-138.5 Ko. = VI.311.9-312.9 K.; transl. Johnston, revised

This passage leans heavily on a perception endemic in ancient thought that regarded physical beauty as an index of moral decorum. The connection between aesthetic and moral distinction formed a value system, corroborating the proverbial belief that a sound soul dwells within a sound body and thus advocating balance between the two.⁴³ This idea affected people’s social perception too, as their deformed body would signify debauchery and hence trigger condemnation by others, who would see them as social outcasts, if not positively sub-human. Galen seems perfectly aware of such attitudes in a section of his Commentary on Hippocrates’s ‘Epidemics VI’ (4, 9, 206.23-207.1 WP = XVIIB.150.8-151.5 K.), where he introduces a moralising note into his Hippocratic source⁴⁴ when he says that it is ‘entirely shameful’ (αἴσχιστον) for a doctor to exhibit scruffy fingernails, halitosis, body odour and other ‘unnatural’ (παρὰ φύσιν) somatic conditions. That Galen is interested in the ethical components of the physician’s demeanour is also seen from the fact that his moralising twist proceeds from his preceding exegesis of the Hippocratic term σχῆμα denoting character,⁴⁵ analysed immediately before the passage on the doctor’s corporeal filthiness. In explicating σχῆμα, Galen develops in particular the moral rectitude demanded of a doctor, i.e. he should be modest and approachable with the patient, not frivolous or snobbish (Hipp. Epid. VI, 4, 9, 205.11-20 WP = XVIIB.148.7-18 K.).⁴⁶

On another level, as is obvious from the recurrent forms of aischros in the passage quoted from Matters of Health, Galen bombards the reader with the notion of shame expressing popular disapproval. Feeling shame at one’s own failings was another important resource for achieving a happy life in the ancient world, in that it coincided with the need for politesse and respect for oneself as much as for others in the context of the community.⁴⁷ In that respect, Graeco-Roman society fits the rubric of a culture that the twentieth-century para-Freudian anthropology of Ruth Benedict has termed ‘shame-culture’, namely a culture in which violation of moral standards engenders shame, unlike a ‘guilt-culture’ in which the same violations give rise to guilt instead.⁴⁸ In dealing in more detail with the operation and characteristics of shame, Benedict, along with Bernard Williams, have argued that shame implicates fear of exposure to the stigmatisation and mockery of the world,⁴⁹ which constitutes ‘a fantasy of an audience’ or an ‘imagined gaze’ staring at moral transgressions. Both authors have therefore underscored the importance of seeing and being seen and of the revelation of the sight of a moral crime in their conceptualisation of shame.⁵⁰ Remarkably, these are all features that in some ways go back to Roman conceptions of pudor, as evinced particularly in Robert Kaster’s sixth ‘pudor-script’: ‘Upon (or at the prospect of) seeing myself being seen in discreditable terms, I have an unpleasant psychological response, when the behavior or state of affairs that prompts the attention is “up to me” and entails discreditable “lowering” of the self.’⁵¹ This experience of shame (albeit a virtual one in the Galenic passage quoted above) occurs when one’s feeling of esteem is imperilled, and this is particularly crucial in a society in which sanction lies in public opinion: ‘What will people say?’. The Stoics envisioned shame as an eupatheia, a commendable emotion that denoted watchfulness for the prospect of justified castigation.⁵² This was, to their minds, a strategic means of protecting one’s self-respect, not an egocentric sense of pride and self-confidence, but rather a feeling of behaving with honour and dignity in performing one’s assigned universal or cosmic duties as a rational human agent.⁵³ Those conceptual parameters, and especially the externalised character of shame, fit comfortably with Galen’s own understanding of shame in several places in his corpus (more on this in Chapters 4 and 5), including in the passage cited above.

Galen, then, for the sake of his readers, exploits the sense of being ashamed by making it an instrument for avoiding imprudent actions. This course of action, with its strong philosophical antecedents (especially in Aristotle),⁵⁴ enables Galen to articulate a brief moral commentary in this health-centred context. Thus he uses the ideal of an honourable death as opposed to a disgraceful life (ἑλέσθαι δὴ μυριάκις τεθνάναι, πρὶν τοιοῦτον ὑπομεῖναι βίον in the San. Tu. extract above). This brings to mind the morality generally held to be associated with Homer’s heroes (e.g. Ajax or Achilles), as mediated above all by the Socrates of Apology 28b-29a, that was kept alive in subsequent Greek popular ethics. Galen transposes this ideal to the domain of decision-making on health issues: this time shame due to incontinence that upsets one’s bodily temperament elicits strong social accusation (and not just ridicule as previously seen in The Capacities of the Soul).

The same heroic ideal of the honourable death features in another passage from The Capacities of Simple Drugs, where shame due to bodily deformity is also in play. However, in this case there is no suggestion that the patient is to be condemned for erroneous preferences. For the text does not cast him as culpable for suffering from elephas,⁵⁵ despite the fact that this skin disease was generally known to have originated from the patient’s lifestyle, including their diet.⁵⁶ On the contrary, the emphasis is on the patient’s rare philosophical consciousness (‘he was more philosophical than the majority of other men’, φιλοσοφώτερος ἢ κατὰ τοὺς πολλούς, SMT 1.1, XII.314.11-14 K.; cf. SMT 1.1, XII.313.8-10 K.; transl. mine) that instinctively leads him to opt for death rather than a life of pain, disfigurement and, ultimately, dehumanisation.⁵⁷ The implication is that even if this patient was indeed responsible for his disease, owing to some form of lack of self-discipline, he had the philosophical stamina to bear the consequences of his actions, thus retaining his self-respect. Both sections, then, underscore, from distinct viewpoints, the role of high-mindedness in issues of the body: the former passage, taken from Matters of Health, shows that self-control is needed to prevent the onset of disease, the latter, from The Capacities of Simple Drugs, that nobility of spirit is needed to face up to disease when it occurs. Remarkably, Aretaeus, who provides the longest surviving nosological testimony on the so-called elephant disease, does not discuss issues of moral responsibility or philosophical attitudes to the disease, which further highlights the markedly moralising aspect of Galen’s disease narratives.⁵⁸

It is in contexts such as those just examined that Galen introduces moral uprightness to medical treatment of the body. In doing so, he goes beyond the clichéd – often brief – emphasis of other authors on the importance of moral life to psychosomatic wellbeing.⁵⁹ Galen probes the philosophical aspects of moral life in a variety of perceptive ways, informed by his programme of practical ethics, as recorded in other parts of his oeuvre, for example, in delving into the particulars of social shame or in sketching individuals as moral entities and not just embodied ones. Similarly, he insists that the philosophical responses to disease seen above do not come about all of a sudden, but demand long-engrained training in philosophical education and sustained efforts at shaping proper moral habits. His focus on the social and cultural aspects of health is also decisive. We have seen that it is the social environment responsible for the disruption of the body’s normal function that attracts Galen’s attention and makes him venture into the ethical sphere, often quite unexpectedly given the technical nature of his works. This aspect underpins his self-projection as a moral authority, another trait not found in other medical authors concerned with similar issues.

The final sentence of the passage from Matters of Health quoted above portrays Galen as a moralist renouncing his ability to correct intemperance, stating that this is not a suitable occasion to do so. This points allusively to Galen’s activity qua ethicist proper in his ethical works, but in the context of Matters of Health it may also be seen as a sophisticated tactic of self-effacement. By mapping out the community’s inimical responses to incontinence (ἀκολασίαν) as well as shamelessness (ἀναισχυντίαν) and moral weakness (μαλακίαν), vices that play a central role in his adversaries’ (un)ethical portrait too, Galen does in a sense correct (ἐπανορθοῦσθαι) incontinence in readers on a metanarrative level, on the assumption that they would have exercised their comparative and abstractive abilities discussed in the previous Chapter, and have had the appropriate reaction – in this case recognising the need to avoid shamelessness. So by bringing out the ethical connotations of incontinence in his technical discussion of hygiene, Galen makes use of the prospect of a metatextual development of character. And that he assigns a naturalistic substrate to character in Matters of Health does not mean that the salience of moral philosophy in individual thriving is readily dismissed from his account.⁶⁰

In fact, ethics also forms a close alliance with Galen’s medical science when it comes to the learning and teaching of medicine, as we can see from the relevant remarks in The Different Kinds of Fever. In describing the characteristics of students of medicine who only have a conceit of medical knowledge (οἴησιν δ᾽ἐπιστήμης) but are ignorant of a significant amount of the true art, Galen lists a number of vices associated with their ignorance: boastfulness (ἀλαζονείας), insensitivity (ἀναισθησίας), rashness (τόλμης), vain prattling (ματαίας φλυαρίας). He then clarifies that his writings on medicine are aimed specifically at passing on true knowledge (ἐπιστημονικόν) and offering instruction in a didactic manner (διδασκαλικόν) (Diff. Feb. 1.3, VII.280.8-281.5 K.), which in general he considers philanthropic (φιλάνθρωπον, Diff. Puls. 4.17, VIII.764.1-3 K.), most probably on the grounds that his teaching – albeit indirectly – eradicates the damaging passions triggered by ignorance. In punctuating his medical texts with relevant moral reflections, Galen renders them more intellectual, philosophical and fashionable, thus widening the appeal of his art to a larger group of followers. These are issues explored in more detail in the Chapters that follow.

In the next Chapter we will investigate another important respect in which Galen differs from other medical authors in his treatment of ethics, and that is in his conceptualisation of the role of medicine in society and culture.