The Sacred Disease as a pradigm of mental disease in
In the late 5th century B.C., the author of the Hippocratic treatise On the Sacred Disease is the first to offer a rational explanation concerning the aetiology of a disease that the majority of his contemporaries still considered to be due to supernatural powers. Based on his description of its characteristic symptoms and signs, since then, the term Sacred Disease has often been interpreted as a synonym of grand-mal epilepsy. However, the pathology attributed to the Sacred Disease is much more ample than the description given by the author of the Hippocratic treatise, as it also comprises an ample spectrum of psychotic symptoms and behavioral abnormalities. The Sacred Disease is a part of the inherited conglomerate of magical, theurgic and animistic concepts of disease aetiology in Greek antiquity that in the course of time gradually will be replaced by mechanistic, rational, "scientific" concepts.
A comprehensive description of the symptoms and signs of the Sacred Disease is not found in ancient Greek medical literature. However, elements of the pre-rational concept of the Sacred Disease may be identified in the Greek literature of the 5th century B.C., especially in the description of tragic heroes driven insane by divine influence. The Sacred Disease as a paradigm of mental and behavioral dysfunction caused by supernatural powers is the ideal foil for the description of abnormal behavior in classic Greek tragedy. Both aggressive (e.g., the protagonists of Sophocles' Aias or Euripedes' Heracles) and paranoid tragic heroes (e.g., Io in Aischylos' Prometheus Bound or Orestes in Euripedes' Iphigenia in Taurus or Orestes) are described (or shown on scene) with a pathology that contains--in a variable combination--both "epileptic" (initial cry, distorted eyes, salivation, spasms, postictal sleep and amnesia) as well as "psychotic" (anxiety, agitation, scenic and acoustic hallucinations) symptoms. For all these different characters and situations, the tragedians provide a uniform disease description, i.e., that of the Sacred Disease. The use of symptoms and signs of the Sacred Disease to depict tragic heroes that have lost their mental sanity makes divine influence as a supernatural cause of the mental disturbance obvious to the spectators of the 5th century B.C.. The implementation of isolated symptoms of the grand-mal ictus indicates the paradigmatic role of the Sacred Disease for the dramatic presentation and does not justify the assumption that the Greek tragedians intended to show "epileptics" on stage.
From the 4th century B.C., a continuous differentiation between the concepts of epilepsia (grand-mal epilepsy), mania (non-febrile psychotic diseases) and phrenitisCorpus Hippocratum and later medical works, and this development gradually enters public awareness. Consequently, tragedians of late antiquity are able to refrain from using epileptic symptoms for the description of tragic heroes driven insane by supernatural powers, as they are able to rely exclusively on the description of psychotic symptoms to convey the impression of a tragic hero arbitrarily driven insane by divine powers (e.g., Hercules' madness in Seneca's Hercules furens).
Session IX -- Early Neurosciences
Sixth Annual Meeting of the International Society for the History of the Neurosciences (ISHN) and