Chapter 7 - Recognising the Best Physician

Summary

Chapter 7 sets Recognising the Best Physician at the heart of its discussion, moving the focus from popular philosophical works to tracts of social commentary that are rich in ethical references or subtexts. I suggest that, despite its content being closely related to the material discussed in The Best Doctor is Also a Philosopher, the latter contains a more generalised advocacy of how the proper doctor ought to behave, whereas Recognising the Best Physician restricts its focus to treating Galen’s individual virtues, and renders self-projection more central to the narrative. This enables Galen to provide a more pragmatic account of the connection he envisaged between medicine, ethics and society, and place the morally didactic function of medicine in particular at the forefront of his intellectual horizons. I highlight how Recognising the Best Physician offers a plethora of passages discussing moral issues, for example the emphasis on the value of truth over deception, the issue of flattery and the ethical corruption of contemporary society. I show that to better illuminate the immorality of his medical colleagues, Galen, inspired by philosophical intertexts, notably the Republic and the Gorgias, creatively likens them to wicked and dissimulating orators. By also attributing features of self-interested politicians familiar from Platonic metaphors to contemporary charlatan physicians, Galen recategorises his rivals’ abilities and undermines their moral standing to suggest that the ideal kind of medicine to combat public disorder is the moral medicine embodied by himself. To that end, Galen sketches himself as a Platonic helmsman, entrusted with a humanistic vocation and safeguarding social and political stability.

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

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

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

The flatterer-physician

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

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

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

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

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

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

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

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

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

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

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

Gorgias, 521a-b; transl. mine¹²

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

The skilled helmsman-physician

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

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

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

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

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

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

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

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

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

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

Gorgias, 521d-e

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

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

Genuine medical art in the service of society

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Autobiography and Galen’s philosophical medicine

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

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

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

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

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

Conclusion

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

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

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