including dysthymia, paranoia, and the role of sexual tension and anxiety inhysteria. He developed a system of spirits (forces), beginning with physicalspirits, associated with the liver and modified through digestive andreproductive functions to become vital spirits, associated with the heart andmodified through circulatory and respiratory functions to become animal orpsychic spirits, associated with the brain and nerves. Emotional disturbancewas not due to failure of reason, but due to an imbalance between aspects ofthe soul, which had rational, irrational, and lustful parts.Therapy during Roman times appears to have consisted mostly of humaneconfinement, decreased exposure to stimuli, and the encouragement of reading,education, and participation in drama. Whether this was only for the upperclasses or extended to the population as a whole is unclear. In addition agreat deal of healing took place at the temples of Apollo, through the Cult ofAsclepian. Sufferers would enter the temple, undergo purification rituals,take special diets, and use narcoleptic fumigations that would induce sleep.Music was also used to sooth and create the right atmosphere. During thedream the god Asclepian would appear and produce a cure. There are manytablets surviving that attest to cures.
With the ascendancy of Christianity to predominance in the RomanEmpire and the later collapse of the Roman Empire, Christian dogma became thebasis of philosophical inquiry in the west. Platonic ideas were combined withChristian teachings, creating a worldview that dominated in the west forseveral centuries. St. Augustine (354-430 A.D.) championed Platonicconceptions of the mind, including the essential dichotomy between body andmind/soul. The mind was seen as having three parts: reason, memory, and will,while memory, in turn, had three parts: the unconscious, the preconscious, andthe associative. Posidonius, in the 4
century, postulated three divisionsof the brain with imagination in the forebrain, understanding in the midbrain,and memory in the hindbrain. There were efforts to build a correspondencebetween the humoral theories of Hippocrates and Galen and Christian belief.Psychological issues were seen within a theological and moral framework.Medieval concepts of mental illness stressed that individuals had free willand were responsible for their actions, but that illness (including mentalillness) came from sin and resulting punishment from God or possession by thedevil. Theological and humoral concepts were not incompatible in thattheological precepts addressed ultimate causes of illness, i.e., why a certainperson became ill, rather than specific mechanisms of illness. Thusmelancholia was seen as a trial of faith. Mental illness was seen as eitherthe result of sin or as a test of faith. For instance of the seven deadlysins – pride, covetousness, lust, anger, gluttony, envy, and sloth – sloth(
) had a clinical profile, presenting with boredom, depression,obsessions, anxiety, and a variety of psychosomatic symptoms. It wasespecially seen to inflict isolated monks, novices struggling to achievespiritual ends, and hermits. Isolation was felt to contribute to it and itwas treated with prayer, community involvement, and work. Since sin wascentral to mental illness, religious activity was central to cure. Mentalillness was seen as alienation from God, thus return to God was essential forcure. Treatises were written on pastoral guidance. Confession and penancewere essential to the cure. Certain monasteries became centers for thetreatment of mental illness, as well as other illnesses, which were also seenas due to lack of faith and sin. In addition, earlier treatments usingpurgatives, bloodletting, and such practices as trepanation were continued.3During the High Middle Ages, from the 11
century on, there was a