ASCLEPIADES (124 B.C.-?)

This early physician, who anticipated many modem ideas on mental illness, was born in the Greek colony of Bithynia and migrated to Rome at a time when that city was replacing Alexandria as the medical center of the known world. At the start of his career he devoted himself to rhetoric, but he soon became interested in medicine, basing his theories on the views of Democritus who held that the body is made up of atoms and corpuscles in continual motion. Illness, according to Asclepiades, is brought about by restricting the harmonious motion of the atoms, and treatment consists of restoring the original harmony through change of diet, exercise, bathing, massage, and emetics. He strongly objected to many of the extreme and inhumane treatments, such as bleeding, which were widely applied at the time.Asclepiades’ approach to mental illness was remarkably similar to his approach to physical illness. Here too he advocated humane treatment, pointing out that confining a patient to a dungeon would fill him with terror and prevent his recovery. His aim was to provide comfort for the afflicted, and to restore mental balance through “musical harmony and a concert of voices,” “a hundred kinds of baths,” and the soothing effect of a gently swaying bed suspended in the air. He also advocated well-lighted rooms, ample fresh air and congenial activities.Asclepiades was far in advance of his time not only in prescribing humane methods of treatment, but in his understanding of mental illness itself. He objected to the term “insanity,” on the ground that it was based on the layman’s reactions rather than on a clinical description of cases. He introduced the modern idea that emotional disturbances, which he called “passions of the sensations,” are at the root of mental disorders, and he was the first to differentiate acute from chronic conditions. He also showed remarkable awareness of the nuances of behavior by distinguishing delusions from hallucinations, in spite of the fact that his Greek and Roman contemporaries believed them to be identical. It took nearly two thousand years for psychiatry to fully recognize this distinction.