Greek and Roman Approaches to Mental Health: From Humors to Early Psychiatry

Long before MRI scans and modern psychiatry, ancient Greek and Roman thinkers were already asking a radical question: what if mental illness is not a curse from the gods but a problem inside the body itself? Their answers, formed roughly between the 5th century BCE and the 2nd century CE, laid the foundation for how we still talk about depression, anxiety, and mood disorders today. From Hippocrates’ bodily fluids to Aristotle’s reflections on the rational mind, this era marked one of the most important shifts in human thought about mental health.

The shift from supernatural to natural explanations 🔗

Before the Greeks, most ancient societies linked mental illness to demonic possession, divine punishment, or supernatural forces. Treatments often involved exorcisms, rituals, and in some cases even trephining the skull to release evil spirits. Hippocrates of Kos (c. 460-375 BCE), often called the father of medicine, broke decisively with this tradition.

He argued that mental disorders had natural, physical causes that could be observed, classified, and treated. This idea was part of a broader Greek intellectual movement away from supernatural explanations of the world and toward what we would now call scientific reasoning. As medical historians note, this orientation forced physicians to closely observe their patients, since environment, diet, and bodily symptoms suddenly mattered in a way they never had before.

Hippocrates and the theory of humors 🔗

At the heart of Hippocratic medicine was the theory of the four humors. According to this framework, the human body contained four vital fluids: blood, phlegm, yellow bile, and black bile. Each humor was linked to a season, an element, and a set of qualities like hot, cold, dry, or moist.

Hippocrates proposed that good health depended on these fluids being in proper balance. When one humor became excessive or deficient, the result was illness, including mental illness. This was a revolutionary claim, because it meant that conditions like depression or mania could be explained the same way as fevers or digestive problems. As outlined in the Hippocratic text On the Nature of Man, pain and disease occur when one of these substances is present in excess, in deficiency, or separated from the others.

The four temperaments 🔗

The humors were also used to describe personality. Later writers, building on Hippocrates, linked each fluid to a specific temperament:

Sanguine (blood): cheerful, sociable, optimistic. Phlegmatic (phlegm): calm, slow, reliable. Choleric (yellow bile): irritable, ambitious, quick-tempered. Melancholic (black bile): thoughtful, anxious, prone to sadness. This framework treated physical health and personality as part of the same biological whole, an idea that influenced medicine for nearly two thousand years.

Treatments based on humoral balance 🔗

Because illness was thought to come from imbalance, treatment aimed to restore equilibrium. Common methods included bloodletting, induced vomiting, purging, special diets, exercise, baths, and rest. The Roman writer Celsus, for example, recommended bloodletting or hellebore-induced vomiting for melancholia, along with intellectual activity and abstaining from wine. These methods may seem harsh today, but they reflected a serious, structured attempt to treat mental disorders as medical problems rather than moral failings.

Major mental disorders identified in the Greco-Roman era 🔗

One of the most lasting contributions of Greek and Roman medicine was the effort to name and describe specific mental conditions. Hippocrates classified mental illness into broad categories such as melancholia, mania, and phrenitis (brain fever), and gave each detailed clinical descriptions. This was the first systematic attempt to organise mental disorders into distinct diagnostic groups, a direct ancestor of modern psychiatric classification.

Melancholia 🔗

Melancholia, which we would today recognise as depression, was one of the most thoroughly described conditions. Hippocrates believed it was caused by an excess of black bile and identified symptoms such as despondency, food aversion, insomnia, irritability, fear, low self-esteem, and anxiety. The Roman-era Greek physician Aretaeus of Cappadocia later described melancholic patients as fixed on a single thought, with unrelenting sorrow and grief.

Galen of Pergamon, the famous physician to the Roman emperor Marcus Aurelius, developed an even more detailed model. In his work On the Affected Parts, he explored how different humoral abnormalities produced different subtypes of melancholia, and connected these to personality types like sanguine, choleric, melancholic, and phlegmatic.

Mania 🔗

Mania was understood as a state of excessive excitement, agitation, and sometimes elevated mood. It was often described as the opposite of melancholia, with symptoms like poor appetite, sleeplessness, irritability, long-lasting fears, and sometimes delusions or hallucinations. Strikingly, Aretaeus suggested that mania and melancholia might be different expressions of the same underlying condition, an idea that foreshadowed the modern concept of bipolar disorder by nearly two thousand years.

Hysteria 🔗

Hysteria, from the Greek word hystera meaning uterus, was a condition attributed almost exclusively to women. Greek physicians believed that the uterus could become dry and move around the body in search of moisture, causing anxiety, sensory disturbances, and convulsions, an idea often called the “wandering womb.”

The anatomical explanation was completely wrong, and this diagnosis later contributed to centuries of harmful, gendered ideas about women’s mental health. Still, the symptoms described, emotional volatility and physical complaints without a clear organic cause, overlap with disorders that are recognised today, such as somatic symptom disorder and certain anxiety conditions.

Phrenitis and epilepsy 🔗

Phrenitis was used to describe acute mental disturbance accompanied by fever, often resembling what we might now call delirium. Epilepsy, which the Greeks called the “sacred disease,” was a particularly important case. In his treatise On the Sacred Disease, Hippocrates argued that epilepsy was no more divine than any other illness, and that it had natural causes located in the brain. This was a powerful statement of the naturalistic approach.

Greek philosophers and the mind 🔗

Alongside physicians, Greek philosophers shaped how mental health was understood. Their focus was less on diagnosis and more on the relationship between body, soul, and reason.

Plato’s view 🔗

Plato (c. 428-348 BCE) saw mental health as closely tied to virtue, harmony, and the rule of reason over passion. In dialogues like the Charmides, he linked mental wellbeing to the virtue of sophrosyne, often translated as temperance or “healthy mindedness”. A well-ordered soul, in his view, was one in which reason governed the appetites and emotions.

In the Timaeus, Plato suggested that all human beings are, to some degree, mentally unwell because they live in imperfect bodies that interfere with the rational soul. He recognised that physical conditions could affect mental life, but he was cautious about medical treatments and emphasised philosophical reflection, education, and lawful living as paths to mental health. Scholars note that Plato was somewhat unusual among ancient thinkers in being skeptical of medication for mental illness, preferring moral and educational remedies.

Aristotle’s view 🔗

Aristotle (384-322 BCE) took a more biological approach. He treated the soul and body as deeply interconnected and was comfortable accepting that mental disorders could have physical origins, with treatment carried out by medical doctors. He noted that drugs (pharmakeia) and dietary measures were used to cure people of bizarre beliefs and mania, and he generally relied on physicians for the actual treatment of mental illness.

Aristotle also tied mental health to the exercise of reason, the function he considered uniquely human. For him, a flourishing life, what he called eudaimonia, required the rational regulation of emotion and desire. Mental illness, in this framework, was a kind of departure from the rational, well-functioning life characteristic of human beings.

Roman contributions and Galen’s legacy 🔗

The Romans largely inherited Greek medical thought and refined it. Roman physicians like Celsus, Soranus of Ephesus, and especially Galen extended Hippocratic ideas into more detailed clinical systems. Soranus is remembered for advocating relatively humane treatment of patients with mental illness, including good food, comfortable lighting, music, and conversation, instead of harsh restraints.

Galen’s enormous body of work synthesised humoral theory with anatomy and philosophy, and his ideas dominated European and Islamic medicine for more than a thousand years. The four temperaments framework, derived from his elaborations on the humors, continues to echo in modern personality vocabulary, even though the underlying biology has long been disproven.

Why this era still matters 🔗

The Greek and Roman period did not produce a perfect understanding of mental health. The humoral theory was eventually replaced by germ theory, neuroscience, and modern psychiatry, and ideas like hysteria caused real harm, especially to women. After the fall of the Roman Empire, much of this progress was reversed in parts of Europe, where mental illness was once again attributed to demonic possession and treated through exorcism or punishment.

Yet the core insight from this era endures. Greek and Roman thinkers established that mental disorders are medical conditions worth observing, classifying, and treating with care, not signs of moral weakness or supernatural punishment. They built the conceptual bridge between superstition and modern psychiatry, and many of their terms, melancholia, mania, hysteria, temperament, are still embedded in how we speak about the mind today.

What do you think? If ancient physicians could identify depression, mania, and anxiety more than two thousand years ago, why do you think stigma around mental illness still persists today? And how might recognising this long history change the way we talk about mental health in our own communities?

References

1. https://fherehab.com/learning/humors-ancient-mental-health
2. https://journalofethics.ama-assn.org/article/legacy-humoral-medicine/2002-07
3. https://en.wikipedia.org/wiki/Humorism
4. https://curiosity.lib.harvard.edu/contagion/feature/humoral-theory
5. https://en.wikipedia.org/wiki/Mental_illness_in_ancient_Rome
6. https://opentext.wsu.edu/fundamentalsofpsychologicaldisorders/chapter/1-4-the-history-of-psychological-disorders/
7. https://www.haaretz.com/archaeology/2025-09-09/ty-article/a-brief-history-of-depression-in-the-ancient-world/00000199-2d9b-df0a-a3bd-7fffe3950000
8. https://psychology.town/fundamentals-of-mental-health/greek-roman-perspectives-mental-illness/
9. https://www.psychologytoday.com/us/blog/hide-and-seek/201203/plato-and-aristotle-health-and-disease
10. https://journals.sagepub.com/doi/full/10.1177/0957154X18803508
11. https://www.saskoer.ca/abnormalpsychology/chapter/part-2/