Chapter 8 - Prognosis

Summary

Chapter 8 shows how close Galen is to the style and language of a practical moralist by focusing on the previously neglected moral aspects of Prognosis. The rich ethical material that Galen includes on the way his society functions and the role of physicians is construed as moral reportage, which also enables him to provide the image he constructs of himself as a medic with profoundly moral features. The essay’s preface stresses the quest for truth and the exercise of correct judgement as moral principles advocated by Galen for physicians and all other professionals as thinking beings. This, I suggest, has a strong theoretical background expounded upon in Galen’s ethical work, pointing to his ideological coherence on ethics and its uniform application across texts of a (seemingly) different purpose. The preface is also informed by Galen’s perception of the morality of doctors addressed in the Therapeutic Method, which I see as a sibling account of Galen’s conceptualisation of medicine as a virtuous art. Furthermore, the delineation of moral character is made central to Galen’s notion of the proper physician, which explains the fact that he formulates his text in such a way as to distinguish himself and his peers from charlatans and sophists, a group of moral outsiders traditionally depicted as quarrelsome and vainglorious. This Chapter also discusses the sophisticated discourse on malice and contentiousness that Galen sets up within the context of some of his medical case histories. The analysis of the writing technique and structure of the case histories as much as of the characters involved offers unique insights into Galen’s account of emotions, especially their causes, consequences, theorisation and phenomenology. This Chapter concludes by stressing how in these instances Galen’s medical activity impinged on the formation and sometimes the development of his moral ideas. In Prognosis ethics emerges as a robust area of thought, study and professional performance in Galen.

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