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Staying Healthy with Galen, or "Do Less, Live Longer"
Staying Healthy with Galen, or "Do Less, Live Longer"
by John Wilkins
March 4, 2024
Many modern health problems stem from abundance and overwork. In this essay, John Wilkins explores how Galen might help provide a solution to some contemporary health issues, and how the key to longevity and health might require less effort, rather than more.
Prof. John Wilkins is an emeritus professor at the University of Exeter. He has published on Greek tragedy, comedy, food discourses in antiquity, and Galen.
Modern health authorities such as the World Health Organization predict that the main threats to health in all five inhabited continents by 2030 will be heart disease, depression, and diabetes—all illnesses produced in part by our modern lifestyles. The time may have come for a reconsideration of Galenic medicine, a system discarded by medical science since the discovery of microbiology in the 1850s, but that offered a robust framework for understanding the body in its social and cultural setting. In this article, I address Galen’s proposals for preventive medicine within Greco-Roman culture of the second century CE—that is, “preventive medicine” as a way of life which maintains a person’s health. In a final section, I consider how Galen might contribute to improving health and wellbeing in the twenty-first century.
A portion of a mosaic floor depicting the head of a boxer, from the exedra of the palaestrae of the baths of Caracalla, ca. AD 200, National Museum of Rome, Baths of Diocletian; Source: Wikimedia Commons.
Much of Galen’s advice on healthy living appears in his treatise Hygieina, translated by Peter Singer as Health (Cambridge Galen Translations, Cambridge 2023) and by Ian Johnston as Hygiene (Loeb, Cambridge, Mass. 2018). These translations—Singer’s more extensive with explanatory notes and a long introduction, Johnston’s in more technical medical language—have rescued Galen’s valuable treatise from the misleading translation of R.M. Green (Hygiene, Springfield, Illinois 1951), who, while splendidly mediating Galen to the post-war American public, nevertheless translated technical terms inconsistently and introduced plants unknown to the ancient world.
According to Galen, a person can remain healthy for life with little need of a doctor’s advice unless an accident or a serious illness supervenes. Once a doctor has assessed an individual and advised to what extent they deviate from the “best” constitution, the patient is able to follow a lifestyle tailored specifically for them. Galen bases the best constitution on both the external proportions of a body, which he judges according to the “standard” or “canon” of Polyclitus, and the internal mixture of qualities in its tissues and organs. Polyclitus’ lost work Canon discussed the perfect proportions of the male human body, on which he based his bronze statue called the Spear-Bearer around 440 BCE. This statue was copied many times in stone and often stood in the forum of a Roman town. Anyone who wished could check their physical proportions against the ideal. Very few attain such a physical state, Galen reassures us, and so the doctors must help the patient attain the best approximation to that ideal by attending to the internal constitution of their body.
Every person has their own mixture (krasis) of qualities (poiotētes), which can be maintained in a natural balance (symmetria) by monitoring the six necessary activities, which late Arabic authors would transform into the “six non-naturals.” These include one’s ambient air, food and drink, exercise, sleep, physiological balance within the body, and mental health. Each of these must be attended to, but not to an extreme. Balance, both within the categories and across them, is essential to achieving health.
Even with a single, male-centric, ideal, Galen insists that health looks different at every age. His treatise proceeds through human life, starting with the newborn fed by its temperate mother or nurse, through childhood, adolescence, adulthood, maturity to old age, and extreme old age. At each stage a person can be healthy, especially when attention is paid to compensate for the gradual cooling and drying of the body, as we all move from the wetness and heat of infancy to the withered coldness of old age. The baby, for example, requires milk, the old man wine.
At each stage, balance and restraint are vital, while extremes—even of exercise—prove unhealthy. From the earliest years, the baby needs to be trained in rhythm and balance, by cradling from the mother, singing, and even watching mimes in the temple of Asclepius. Such rhythm will train the body in order and balance. Much of one’s youth should be spent in the gym and in the massage rooms of the bathhouse, where any humoral imbalances can be eased out through the pores of the body. For the moderate, standard citizen, daily exercises at the gym and bath complex will set up the body for life, even as far as extreme old age. Some modifications are needed for the elderly (Galen prescribes an ideal daily routine for both an 80- and a 100-year-old man), but maintaining a lifestyle of basic balance will see the old person through. Throughout life, mealtimes must be as regular as possible, since the body likes what it is used to, and, for the old, meals based on lighter meat such as poultry and non-oily fish such as red mullet. Pork is for the young in their prime.
Boxer at Rest, Palazzo Massimo alle Terme, Rome, Italy, 330–50 BCE. Source: Wikimedia Commons
Things can, and do, go wrong, of course, and corrections will inevitably need to be made. For example, Galen spends a lot of time discussing “fatigue” [kopos], which might be caused by unwise exercise, over-eating, or bodily imbalances. Remedies are usually non-invasive, and only in some cases will blood-letting or drug-strength versions of plants be needed.
What seems most enlightened in these practices is the treatment of mental needs alongside physical disorders. In Health, for example, Galen diagnoses physical causes for those suffering from excessive rage and grief and prescribes physical treatments to help, recalling how rhythmical movements help calm children during screaming tantrums.
Galen’s ideas of health and regimen are remarkably individuated. Each person lives in a social world that constructs medicine according to the prevailing cultural values, the available clean water, balance, and proportion. A truck driver, a dancer, an office worker, and a farmer can all be healthy, but health will look different in each instance.
What is striking about this conception of health is how different it is from the ideals proposed in modern capitalist contexts, where health is treated like a substance that can be acquired in ever greater quantities. Compare body builders, long distance runners, or gym-goers spending endless hours in feats of endurance to Galen’s modest and suitable exercises. These are varied and less destructive of the body than the excesses of athletes, whose way of life Galen disfavors. Once an athlete is in peak condition, any further intensification of regimen can cause problems. Indeed, no special equipment is required for being healthy. No fancy orbital machines or specialized weight machines required. No personal trainers or spas needed. Simple exercises can be accomplished at the baths, which were part of everyday life for wide swaths of Greco-Roman society. Just exercise moderately but regularly, eat moderately, and take care not to overindulge or vary your routines too extremely.
When asked, most people will view Galen’s advice as basic common sense. Yet, while these practices may seem obvious, we do not live them, and when things go awry, we feel compelled to intervene in ways far more extreme than his program suggests is helpful. What would be the result of following Galen’s health regimen? Well, we’d eat in moderation with attention to our own body’s needs and engage in fewer fad diets. We’d probably buy fewer products and expect less from our bodies. We might work less, too. Galen is adamant that occupations get in the way of the optimal way of caring for one’s health. It might be difficult for most people to adopt a life of total leisure and freedom, but we still might consider how his reflections on second century CE Rome reflect current realities. Mitigation of excessive stress is possible, Galen thought, but special measures must be put in place to rebalance the body where it occurs. Rather than adopting additional mindfulness practices to counter our abundant workload, we might also try to spend fewer hours exerting ourselves. Opening ourselves up to the “common sense” of Galen might reveal new avenues to rebalance our collective health or help uncover that the solutions we seek have been sitting in front of us for quite some time.
The Sources
Singer, P.N., translated with introduction and notes, Galen. Writings on Health: Thrasybulus and Health (De sanitate tuenda). (2022). New York/Cambridge: Cambridge University Press.
Discussion Questions
1. Do Galen’s recommendations feel like common sense? Where do they surprise you?
2. Galen insists on the uniqueness of the individual. Big statistics, the basis of medical science, have brought many benefits to medicine, but as genetics now confirms, every person is different. Might this insight bring us closer to personalized care as espoused by Galen?
3. How does refraining from extreme exercises and diet trends conflict with modern health practices? Who advocates for more intense interventions in modern health contexts? Who advocates for more moderate measures?
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