Whispers of wellbeing from antiquity

Q&A with Dr Katharine Van Schaik

While many technological interventions of today and the future will help usher in a new era of medicine, health and wellbeing, it is all too tempting to paint a picture of something of a panacea; a cure for all. Perhaps, rather than focusing on technologies, some of the truths about living a long and healthy life can be learned in wisdom from the past.

According to one practising physician, historian and author, Katharine Van Schaik, it is worth exploring history as far back as antiquity to help uncover how our understanding of health and wellbeing has evolved, to understand how these dimensions of life are developing today and will do into the future.

In her book How To Be Healthy – an Ancient Guide to Wellness, Van Schaik, a faculty member at the Department of Classical and Mediterranean Studies at Vanderbilt University, Nashville, explores some of the timeless wisdom, as well as flawed practices, around the issue of how to be healthy in body and mind.

By exploring the work of one of the most prominent physicians of the ancient world, Aelius Galenus, or simply Galen, and in presenting a collection of his texts, the author provides insights into how we can take care of our bodies and minds, prevent disease, and reach a healthy old age, using guidance from the distant past.

Who was Galen and what did he prescribe?

Galen was a philosopher, physician, scientist and writer who came to prominence with his medical practice and writings during the 2nd and 3rd centuries, helping to form the foundation of western medicine up to the 19th century.

Much of what we know today – via the application of modern scientific methods, including clinical trials on large groups – has validated what Galen told us almost two millennia ago.

Galen’s pillars of good health included the practices of exercise, maintaining a nutritious diet, and working on the mind-body connection, for mental health, and what he called “good character” formation. Astonishingly, we now know that much of what he proposed hit the nail on the head.

Q. How deep was his understanding of the underlying mechanics of our health?

Well, the way he puts it all together in terms of describing the physiological mechanisms and pathways, is ultimately flawed when viewed through the lens of today’s science, but the general instruction is sound. Given what we know today about the benefits of lifestyles based around regular exercise, Galen’s emphasis on exercise, “preferably in teams, possibly with a small ball” shows his awareness of such lifestyle benefits, even if he didn’t understand what we know today about physiology.

Q. Presumably a lot of what he wrote would be deemed unimaginable today?

Indeed, medical practice around health and wellbeing isn’t necessarily always moving in the right direction, and the past offers up some red flags. An idea of Galen’s which is now considered dangerous was bloodletting, the practice of solving medical issues by extracting certain so-called “humours” (bodily fluids) including blood, bile or phlegm from the body. This practice became extremely pervasive and was still commonplace until the Enlightenment, up to the 18th century, and in some cases even into the late 19th century. We now know that it caused much more harm than good.

I use that as a thought piece with medical students when making the point that we may be making similar mistakes today in how we tackle and treat many aspects of health and wellbeing. In fact, in many cases our entire understanding of a particular mechanism might be flawed, and it’s likely there are aspects of medical practice and technology today that are having a negative impact on the lives of people, and may do so for years to come.

I think that’s part of the reason why it’s essential to study the past. I think it’s very important for modern practitioners, technologists, and governments, to have that humility to know that in decades and centuries to come, people will look back and recognise that we were utterly misguided.

Q. Did Galen make any predictions on future health which apply to our era today?

One of the remarkable aspects of Galen’s system of thought and practice was his ability to integrate general human physiology, health, and disease, with specific aspects of an individual’s constitution, which can be viewed today — some 1,800 years later — as being analogous to, and a precursor of, precision medicine.

What Galen referred to as constitution we might describe today as a combination of genetic make-up, individual medical history, lifestyle, and behaviour. He says that in an ideal scenario, a physician would know everything there is to know about a patient, from what they eat daily, to what they’ve been exposed to in terms of disease and stress throughout their life. Such a scenario would allow a practitioner to make a diagnosis and then treat the patient accordingly and on an individual basis, he proposed. However, he also noted that only God could know so much!

But today we are on the cusp of a new era where, in the future, with increased use of precision medicine techniques, we will be able to develop enhanced individual therapies. By knowing more about individual make-up we are learning to administer therapeutic treatments in targeted ways that are specific to individual patients, thereby improving treatment efficacy. I think that artificial intelligence (AI) will help with that, especially in the gathering and analysis of data.

Q. Do his texts offer up any warnings for our world today?

Today, as many corporations roll out the next generation of pharmaceuticals and AI in the health and wellbeing space, it’s important to remember that in many cases it is elites who are making these decisions.

Galen was an elite too. He was a man of leisure, who was able to use his time, not in toil and labour, but to write his philosophy. In his writings, he talks about hunting as a form of exercise that is good but only available to “rich men of leisure”. He was also a man of influence and power, who was able to help issues in a harmful era of bloodletting, lasting centuries. So questions around elite power and influence are huge now as we move into the future.

Q. Presumably, elite-controlled technologies will also lead to further inequality in the future?

I am a practising radiologist and in my world, in the USA, I see inequality every day. For example, I see an increased demand for whole-body MRI as a screening tool to assess for malignancy. It is extraordinarily expensive and only available to individuals who can privately pay thousands of dollars. Without intervention there’s no reason to presume this system will improve, providing access for all.

So I think we can expect inequality in health and wellbeing to persist into the future. But if we learn anything from the past, it’s that over time, and especially recently with the advent of advanced technologies, I think we may have forgotten about some of Galen’s pillars of health, like exercise, diet and the mind-body connection. These are aspects of life which everyone can engage in, and in doing so help support themselves and their societies to stay healthy.

Dr Conor Purcell @ConorPPurcell writes about science, society and culture — some of his other articles at cppurcell.tumblr.com.

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