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It can be tempting, amid the chaos of modern life, to look backwards – to yearn for simpler times when smartphones didn’t exist and no one had ever uttered the word “microplastics”. Some turn to Freud, others to the stoics. For one week, I turned to one of the most famous physicians of the ancient world: Galen.
A second-century Greco-Roman physician and philosopher, Galen served as court physician to Marcus Aurelius’s son Commodus. He was also a prolific writer (his texts account for an estimated 10% of all existing Greek literature from before AD350) whose theories shaped western medicine for more than 1,000 years. Now, some of his most significant texts have been collected in the new book How to Be Healthy: An Ancient Guide to Wellness.
His texts explore the mind-body connection, exercise, diet and the definitions of health and disease. While some of his advice is suspect (he suggests that going to the gym makes one “idle, drowsy and slow in judgment”) and some simply impractical (in one exercise he recommends holding back four horses at the same time) there are nuggets of timeless wisdom. In one chapter, for example, he advises that in order to avoid distress, one must practice gratitude for what one has and avoid comparing oneself to others.
If he was skilled enough to keep emperors and gladiators healthy, surely Galen can help me, a thirtysomething journalist who spends most of her day hunched over a laptop.
I come up with a four-point plan of action based on his recommendations. First, in order to identify my own unique shortcomings, Galen suggests I ask older men what they think is wrong with me. Then, for fitness, I have to do something Galen calls “practice exercise with the small ball”. Finally, I must determine my balance of the four humors – four bodily fluids that Galen saw as key to one’s health – and eat according to my “humoral balance”.
But I’m no expert. To make sure I’ve interpreted Galen’s advice correctly, I reach out to Dr Katherine D Van Schaik, an assistant professor of classical and Mediterranean studies at Vanderbilt University medical center, and a practicing physician, who translated Galen’s writing for the book.
“I think your approach is good,” she says. “It incorporates the tripartite approach that he describes, which is addressing the soul, and also diet and exercise,” she says. But she issues a warning. “This is not formal medical advice,” Van Schaik says. Also, she adds, my plan is “very literal” – I could ask some women what they think is wrong with me as well.
Indeed, Schaik’s preface cautions that because much of Galen’s thinking is based on beliefs about human physiology now known to be false (the four humors, for example), “the medical reasoning, diagnostic categories, prognoses and therapeutic recommendations dependent on these theories are ill-advised at best, and dangerous at worst.” She adds, however, that she sought to only translate advice that “a modern western physician might reasonably give, or at least, with which she would not disagree (most of the time)”.
Promising!
Ask elders what they think is wrong with me
In order to become a better person, Galen says, the first thing you need to do is figure out what’s wrong with you.
“Whoever wants to become a fine and good person, let him bear in mind that one is necessarily unaware of many of one’s own errors,” he writes. Many of us, he argues, are simply too in love with ourselves to see all of the ways in which we’re falling short.
In order to determine our unique set of flaws, Galen suggests soliciting feedback from others. Specifically: “older men who have lived the best sort of lives”.
As a woman on the internet, I have been the lucky recipient of older men’s unsolicited feedback for years. And as grateful as I am for that, I cannot be sure that they have lived “the best sort of lives” – no offense.
So I turn to the highest concentration of older men in my life – plus some women, per Van Schaik’s suggestion: my parents’ weekly Zoom call with their friends from college.
After much back and forth, the group settles on one main issue. “You’re too into astrology,” my father reports.
I endeavor to improve myself as these older Capricorn, Cancer and Pisces men have suggested. For the next week, I refrain from checking my three astrology apps in the morning. When I wish a former colleague a happy birthday, I don’t call him an “Aquarian king”. I do slip up one day and look up Truman Capote’s star chart (he was a Libra), but otherwise I remain steadfast.
Practice exercise with the small ball
Galen believed that exercise was an essential part of one’s health, but not all forms of it. For example, Galen disapproved of running because he believed it “has a tendency to thin the condition of the body and provides no training for courage”, which is great because I find it boring.
The ideal exercise, according to Galen, is “the exercise with the small ball”. He calls this activity “convenient”, “accessible” and “comprehensive”, and argues that it “sharpens the mind”.
But Galen never gives instructions for how to do it. He says that one throws the ball, and – alarmingly – that there are “many neck grabs and many wrestling holds”.
I ask Van Schaik if she can elaborate.
“It’s a fun puzzle,” she says. “We’re not entirely sure what it looked like or what the rules were.”
She does offer that the game involved multiple people and a tennis-sized sphere, and that it probably had elements of keep away. “Like a high-octane capture the flag, except you’re throwing it,” she says.
Sadly, I can’t find a big group of people whose necks I can grab. I settle on playing a catch/keep away hybrid with my boyfriend. I throw him a tennis ball and he holds it away from me while I scramble ineffectively to grab it, and my dog races around us barking.
Though I never succeed in reclaiming the ball, this activity is extremely tiring, and it takes me a few minutes to regain my breath. I feel certain that if I did this on a regular basis, I would sustain terrible injuries.
Determine my balance of the four humors
Central to Galen’s concept of health was each individual’s balance of what were considered at the time to be the four bodily fluids, also known as the four humors: blood, yellow bile, black bile and phlegm. Humorism, as this principle of medicine was known, posited that each person’s unique mixture of these fluids was different; a preponderance of one humor or another determined a person’s temperament. Imbalance of these fluids, it was believed, could lead to disease.
Humorism was a pillar of western medicine until the 19th century, when germ theory emerged as the leading explanation for disease. But I’m committed to Galen’s advice, so I embrace this defunct theory. Still, I need some help.
Angela He, a rare books librarian at the Washington University School of Medicine in St Louis who has written about the four humors, outlines the humoral temperaments for me. Those with an abundance of blood were “sanguine”, thought to have cheerful personalities and rosy cheeks. “Cholerics” had an abundance of yellow bile, which supposedly made them quick-tempered. The creative and depressed were known as “melancholic”, and believed to have an excess of black bile, while “phlegmatics” were supposed to be lazy.
I tell He that I am cheerful and my cheeks are frustratingly rosy, so I’m probably sanguine. But I worry that’s what everyone thinks they are, like saying you’re the Carrie Bradshaw of your friend group.
She asks a series of follow-up questions. Do I like spicy food? Yes. Do I sweat a lot? Unfortunately, also yes. She agrees I sound sanguine. For the ancient Greeks and Romans, “blood equals sweatiness”.
I wonder if this is why natural deodorant has never worked for me.
Eat according to my humoral balance
According to Galen, food could help rectify imbalances in a person’s humoral mixture. Each bodily fluid was believed to have certain fundamental qualities – for example, blood was thought to be hot and wet; yellow bile, hot and dry – and so were foods. So a sanguine person, who had an excess of hot, wet blood, was thought to benefit from eating cold, dry foods.
“You might want to add stuff into your diet like mushrooms, lentils and tea,” says He – foods that were considered cold and wet. Beef was seen as a cold, dry food that could balance my sanguine temperament. But I am to avoid foods like lamb, veal, turnips and anything spicy.
“So either wet, kind of flavorless foods, or beef, I suppose,” He concludes.
Over the next few days, I bravely adhere to my diet by going out to restaurants and ordering oysters and steak tartare. This feels amazing. Neither my finances nor my cholesterol would allow me to eat this way all the time, but I wonder if old Galen was on to something.
Conclusion
Did Galen’s health advice make me feel better? Of course not. Humorism was long ago disproven, exercise with the small ball was confusing, and I hated taking older men’s advice.
Still, Van Schaik says she has a tremendous amount of respect for Galen.
“He trained as any MD/PhD student would in the United States,” she says. “He had such a long time devoted to his medical education, and I respect that as a clinician myself.”
Galen’s confident writing also serves as a reminder to modern-day physicians to temper their expertise with some humility, Van Schaik says. “Galen was so sure he was right, and he was wrong in so many ways,” she says. “It’s important for us as physicians today to not be like that. To be more reflective in thinking through, what are we doing wrong? What could we do better?”
An important reminder for all. I think I’m right about astrology being fun though.
