Garson on Hippocrates and the Magicians

Justin Garson in a chapter of his book “Madness: A Philosophical Exploration” (Oxford University Press, 2022) presents a fascinating reanalysis of the clash between the Hippocratic physicians and the “magicians, purifiers, charlatans and quacks” in Ancient Greece. The conflict is often understood as being about a natural vs supernatural orientation to the treatment of illness (and indeed, that’s something I have mentioned in the past in my history of psychiatry lectures with trainees as well), but Garson points out that this explanation is unsatisfactory because the Hippocratic corpus too makes frequent references to the supernatural. Garson proposes that the relevant contrast is instead between dysteleology and teleology, which becomes an early example for him of madness-as-dysfunction and madness-as-strategy traditions of thinking about psychiatric problems.

Garson writes in chapter 1:

“In short, what is specific to the Hippocratic rupture is this: disease originates from a disruption or violation of teleology. It is the negation of teleology. Disease has no goal, no purpose, no end, and it perverts the creature’s ability, and the ability of its parts, to carry out their jobs. Disease frustrates teleology at every level of biological organization. And, to the extent that the purposeful is the good—to the extent to which a creature’s good is found in its parts achieving their ends—then medicine is, necessarily, good, because it restores the creature’s capacity to attain its good. On the contrary, our magicians, our conjurors and purifiers, think of disease as serving, or as satisfying, a purpose, in this case, the purpose of divine retribution, of just penalty for offense. Disease has a reason for being, a telos, an end, an in-order-to. Disease does not represent the frustration of purpose—or not merely its frustration—but its satisfaction. What this means for health is that we must discover, through careful observation, which god has been offended, so we know whom to appease. The split between teleology and dysteleology captures something essential in the schism between the Hippocratics and the magicians. Ultimately, the distinction between teleology and dysteleology can be decisively severed from the distinction between the natural and the supernatural. It is not as if the teleological aligns itself with the supernatural, and the dysteleological with the natural. In a sense, the purpose of this book is to reveal, precisely, how they come apart, and why their independence, their apartness, is necessary for reorganizing the study of madness.

I am not ultimately interested, here, in venturing a thesis about medicine in the ancient world. I wish to identify something like two contrasting traditions that are woven throughout the history of madness. I call the first tradition, this Hippocratic tradition, madness-as-dysfunction. I call the second tradition, the tradition of the conjurors and magicians, madness-as-strategy, or, equivalently, madness-as-design. Madness-as-strategy is protean; it resurfaces in many different guises throughout the centuries. My purpose is to follow its movement through time, to point to it, to speak its proper name, and, in some measure, to conjure it.”

“… this alternative “tradition,” the tradition of which the charlatans and magicians are representatives, madness-as-strategy, has no proper lineage. The priest-physicians had no successor. We find no mandate that a set of precepts or practices be passed on to anybody else. To be sure, we find resemblances, resonances, through history. The exorcists and the witch-hunters of the Christian era were, in a sense, “descendants” of the magicians and purifiers, but not because of a lineage, not because a body of principles and practices was passed down from one group to the other in an unbroken chain. Freud himself sometimes writes of an intellectual affiliation between psychoanalysis and the healing practices of the Asclepian temple. If the madness-as-dysfunction tradition organizes itself into a proper narrative, this other tradition, this madness-as-strategy tradition, is like a child that interrupts that narrative from time to time, but each time in a different costume.”

P.S. See book review by Lisa Bortolotti for the BJPS Review of Books.

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[I plan to occasionally share quotes/passages from books or articles that I find to be interesting and thought-provoking. For such posts, my goal would be to focus on material that the average reader of this newsletter is unlikely to have come across on their own, but would find to be relevant.]