A Case for Ancient Epileptic Psychosis

BY JAZZ Demetrioff

Jazz is a third-year student at the University of Winnipeg, working on a three-year BA in English, a four-year BA in Classics, and a four-year honors in classical civilizations.

          It is not unusual for a physician today to classify and diagnosis madness in a mentally ill patient throughout Western civilization, and this is because of the Hippocratic Corpus and its detailed understanding of the sick, insane and injured. As ancient populations were rising and medicinal understanding was expanding, mental illness became a well-known disorder to the Romans and Greeks. It was not uncommon for someone who was ‘mad’ to seek treatment or shelter from the outside world. Only some people were treated, while there were others who were unable to afford the necessary treatments or the travel to receive them. But there was difficulty in defining what madness was in the ancient world. For us, in the present, mental illness can be classified as one’s derangement from an original personality, but even that is not entirely adequate. In antiquity, madness was not only a type of mental disorder, but was also seen as an illness that affected a person’s humours with an imbalance that caused a person’s body, mind and spirit to change mentally, spiritually, physically, culturally and socially. In the case of a specific emperor from Rome, Gaius ‘Caligula’ Julius Caesar Augustus Germanicus (who from now on will be referred to as Caligula), we see that many ancient authors such as Suetonius, Philo, Cassius Dio, and Josephus discuss not only the life of the emperor, but also his mind and mental state. Modern scholars have different opinions concerning the diagnosis of Caligula; some believe he was in the middle of a mental breakdown. The following will argue that Caligula was seen as a mad man, and that he also suffered from a form of epilepsy. With the use of ancient and modern evidence--while discussing the ideologies found in the ancient sources that refer to mental illness, prognosis, diagnosis, and treatment in the ancient world--this paper will argue that Caligula had epileptic psychosis.

          Firstly, we must consider how mental illness was understood in antiquity. Modern scholars have determined that in antiquity both physical and mental disabilities were the result of a variety of causes and situations that ranged from congenital, accidental, and occupational hazards, through to various misadventures. Commonly the humours are to blame. It is also important to consider the term ‘disease’ and its place in ancient society. According to Vlahogiannis, disease is considered to be a disturbance or a typical functional deficiency, while illness is social deficiency, and that having an impaired mind suggests a plausible degree of disability, which was at a high rate in the ancient world. We are able to conclude this due to literary, epigraphic, iconographic, archaeological and skeletal evidence.  Evidence from the ancient literary sources can provide us with a useful perspective in seeing how civilizations understood mental illnesses. A genre of literature that has the most vivid descriptions of mental illness is Athenian tragedy. Milns says that when we look at this as evidence, we need to remember that playwrights and authors of antiquity were most likely from the upper class, and their attitudes may not be typical of the actual majority. However, this does not imply that just the higher classes had mental illness; it was all classes that were affected by various diseases. The Greek historian Herodotus may not be a tragic playwright, but he describes madness clearly:

“No sooner was he (Cleomenes, Spartan King) back, however, than he fell seriously ill: what have previously been mild derangement was now full-blown madness... Thus tethered, and seeing that the guard was on his own, standing apart from the others, Cleomenes badgered him for a knife…With the iron weapon now in his hands, Cleomenes began to hack at himself, beginning at the shins. Strip after strip of his own fleshed he sliced off…”

In antiquity, it was believed that there were four humours that affected a person’s bodily health depending on which humour dominated the others, as each humour affects a particular body part differently. Evans believes that these proportions led to a mixture that determined someone’s intelligence, temperament, and predisposition. There were four perceived humours. An excess (dyscrasia) of one of these determined the hotness or coolness, and dryness or wetness of a person’s body. Ancient medical doctors would use the humours to diagnosis madness; for instance, patients who were mad from an excess of phlegm were quiet and would neither shout or make disturbances; those who were maddened by excess of bile were noisy, evil-doers, as well as restless and were always doing something inopportune. Furthermore, if the patient’s brain was badly affected, then they would have terrors and attacks, which today we call seizures. One person, in particular, can be a perfect example of “those maddened through bile”: Caligula. The philosopher Seneca mentions Caligula’s madness and calls him a beast. Winterling has noticed in his research on the biography of Caligula that all ancient authors and philosophers, at some point, claim that Caligula was insane, mad, filled with imperial madness or a violent man. It is to say at the very least, that ancient sources had no right or wrong facts on the life of Caligula.

          Caligula was born 31 August AD 12  in Antium, Italy to Germanicus and Agripinna. Suetonius tells us that during Caligula’s time as a child he was living with Augustus, his grandfather, but before the latter’s death, Caligula was sent to his parents with one of his slaves, a doctor. According to this source (a letter purportedly from the emperor Augustus, no less), it seems that in the early years of his life, Caligula did suffer from delicate health. It is said, specifically, that he was prone to epileptic fits. As one can see here, Caligula lacked the upbringing from his mother and father for the earlier years of his life; with that, it could be questioned throughout the events of the future: was this for the better, or for the worst? Did it really affect him in a mental or physical way? It most certainly did. But after this apparent letter from Augustus, we are left with very little to no information concerning the events of Caligula’s youth, until Tacitus tells us that he was with his parents in the Rhine. With the lack of evidence during the majority of Caligula’s childhood, it could be argued that his illness was present at this time, however, we have no proof to assert this argument, and therefore, we have to be careful giving an accurate timeline. Ferrill says that there is evidence that Caligula received special treatment as a child, such as when he was with his parents in the camps: his mother would dress him up in boots and military attire, and Caligula would prance around like he was one of them. This particular example, plus other attentions towards Caligula, started a quarrel between Agrippina and Tiberius. After the death of Germanicus in AD 19, Caligula was placed under the care of Tiberius. Suetonius believes that the death of Caligula’s father was one of the major turning points in the boy’s life, which could have been a possible acceleration in his illness. Yet, there are other times that may have been just as significant: for example, when his mother and siblings were exiled onto an island and later died there (except for his favorite sister Drusilla). Caligula continued his youth-hood and early manhood in a life of turmoil, and had to please Tiberius just to live another day, which brain-washed Caligula into not being emotionally attached to family. Another factor could be the death of his first wife Junia Claudilla who died during childbirth with the baby. Even though these are sufficient examples of some of the possible affects on the boy’s mind, the must prudent that has been discussed and debated upon by ancient and modern sources is the year AD 37, starting with the death of his adoptive father, Tiberius in the Bay of Naples. During his first few months as the new Roman emperor, Caligula was apparently a kind and generous ruler, but in the same year Caligula fell seriously ill, which could have been one of the overall stressors to ignite his madness. Here again, it can be argued against this being the actual trigger point since the evidence, again, loses sight of the emperor, until his return months after. Suetonius’ opinion is clear about how Caligula transformed from the sweet boy to the madman: “So much for Gaius the Emperor; the rest of this history must needs deal with Gaius the Monster.”

          Before examining Caligula’s tyranny and the possible diagnosis of epilepsy that relate to his personality change and mental state, the following will consider Hippocrates’ famous work On Sacred Disease and its relation to Caligula’s madness. The Sacred Disease- epilepsy- is neither more divine nor sacred than other diseases, and Hippocrates claims that it has a natural cause. Our modern definition of epilepsy is very similar to that of Hippocrates’: “a disorder characterized by recurrent episodes of brain dysfunction due to a sudden, disorderly and excessive neuronal discharge.” Epilepsy affected the young, which usually ended in death, as well as the old. However, its effects were less risky. Paralysis was more common when an attack affected the elderly. If someone in the ancient world did have the Sacred Disease, there were many signs of an occurring attack:

“If the phlegm be cut off from these passages (airways), but makes its decent into the veins…the patient becomes speechless and chokes, froth flows from the mouth; he gnashes his teeth and twists his hands, the eyes roll and intelligence fails…”

During his research of the brain, Hippocrates found the relation between the four humours and epilepsy, and he believed that they affected the moistness of the brain, which in turn caused madness. Galen agreed with this idea of the humours affecting the brain, because he argued that mental illness arose when the psychic pneuma was deteriorated by a humour. Plato believed in this ideology and he even divided the psyche into three groups: rational and ruling, passionate and emotional, and appetitive and desiring. We can see that this theory is quite similar to that concerning the humours. Firmicus Maternus believed that the prognosis of excessive moisture led to madness. Toner has noticed that ancient practitioner’s had an interest in focusing their medical studies on the emperors themselves because they believed that the pressure of governing a large empire caused stress, and madness. From this information on the humours, we can argue that both Caligula’s mental illness and epilepsy were due to an excess of moisture in his brain, and that all three groups of the pneuma that Plato had developed, above, were all affected by Caligula’s mental and physical state.

          It was after Caligula’s illness in AD 37 that he started to show signs of tyranny and violence, and it appears that the prevalent general opinion at the time (at least initially) was that this was the aftermath of his illness. According to Suetonius, Caligula could not control his cruelty and viciousness any longer and he would show enjoyment when watching tortures, executions, and would act out with singing and dancing of excitement. Another sign that Caligula had a mental illness was his treatment of his horse, Incitatus. However, Caligula’s behaviour was not simply harmless or assumingly reasonable. For example, during a dinner party, one of Caligula’s slaves tried to steal a piece of silver from one of the couches and was caught; as punishment, Caligula cut off the slave’s hands, tied them around his neck, and stuck a placard on him stating his crime. Dio Cassius emphasizes Caligula’s madness alongside with Suetonius’ ideas of epileptic seizures. It has been noted by Suetonius that Caligula was terrified of thunderstorms, which caused him to hide under his bed. It is unclear, to ancient and modern sources, why Caligula had such a fear of lightning, but medically, loud noises and sharp repetitive blasts of light can cause seizures. There has been some mention of Caligula having insomnia in the ancient records, particularly in Suetonius’, and modern scholars place focus on the sleepless nights from vivid dreams, alcohol abuse, his epilepsy, and fear of seizures, which had been present since he was a young boy.  In fact, through their textual research, scholars believe that epilepsy ran in the Julio-Claudian family.

          It is likely that the trigger point must have been his illness in AD 37, which could have affected his epilepsy and mental state since he showed the signs of irritableness , suspiciousness, egotistical, paranoia and delusions. It can be argued that Caligula had epilepsy, but some modern scholars suggest other reasons for his mental state besides this particular mental illness. Philo believes that Caligula had “mental distress and severe depression,” and Philo even had a personal encounter with the emperor in late autumn of AD 40. Suetonius and Cassius Dio echo this idea in a similar fashion, but Suetonius gives a more detailed reasoning. He suggests that Caligula was unsound, while recognizing that he was mentally ill. Seneca paints Caligula in the darkest manner possible by using the words like: dementia, furiosa, and inconstantia. Some scholars, such as Balsdon, Winterling and Barrett, tend to agree more with Philo and Suetonius, believing that Caligula’s illness was the cause of a nervous breakdown. Others, such as Sandison, Katz, Marãnón, and Ferrill, suggest that Caligula suffered from epidemic encephalitis, or lobe epilepsy. However, all of these modern scholars have one thing in common: they cannot be definitive in respect to Caligula’s diagnosis.

          In conclusion, from studying the life and mental prognosis of Caligula, it seems most likely that he suffered from a form of epilepsy, perhaps epileptic psychosis. Caligula had many of the symptoms of epileptic psychosis, and some may have caused abnormal behaviour, and may have perhaps created a wicked personality. It was not entirely Caligula’s fault that he turned out to be a horrible person, however, people in the ancient world did not understand this, and took Caligula’s illness differently. The Sacred Disease has genetically been passed on through the years into the present, and thankfully, with our knowledge today, we are able to diagnosis it with better understanding. Caligula, on the other hand, was just a pawn in the genetics of his family’s health, which, in the end, made him into the deranged being who we have come to know today.


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