Psychotherapy In Egypt

Among the Egyptians the first great development of medicine came among

the priests. The two professions, the medical and priesthood, were

one, and the temples were the hospitals of the time. We have stories

of people traveling long distances to certain temples in the early

days of Egypt and also of Greece. Often the sick slept in the temples

and dreamed of ways by which they would be cured. The stories make one

feel th t somehow the sleep which came over them was not entirely

natural and spontaneous, but must have been something like hypnotic

sleep. As for the dreams, the suggestions of modern time given in the

hypnotic condition seem to be the best indication that we have of what

happened in those old days. Certain it is that the persuasion of the

patient that he would get better, the influence of the diversion of

mind consequent upon his journey and the regulation of life under new

circumstances in the temple, with the repeated suggestions of the

priests and of their various remedial measures, as well as those due

to the fact that other patients around him were improving, all plainly

show the place of psychotherapy at this time.



Much of the old-time therapy was in association with dreams supposed

to have been in some way inspired. This was true at Epidaurus, at Kos,

at Rome, at Lebene, at Athens, and at every place we know of where

cures were worked in the olden times. To the modern mind it seems

impossible that dreams should come so apropos unless they were in some

way directed. The only explanation seems to be the use of suggestion,

with the probable production of sleep resembling our modern hypnotic

trance. Apparently the patient's attention was little directed to the

origin of the suggestions received, but he remembered and benefited by

them.



The most explicit testimony that we have to the antiquity of

psychotherapeutics and to the employment of the influence of the minds

of patients over their ailments in the olden time is in Pinel's

"Nosographie philosophique" and in his "Traite medico-philosophique

sur l'alienation mentale."



Pinel himself will be remembered as the great French psychiatrist who,

confident that he could control most of them by mental influence,

first dared to strike the chains from the insane in the asylums of

Paris, at the end of the eighteenth century, when for more than a

century they had been treated more barbarously than ever before in

history. The passage makes clear that the writer himself, over a

hundred years ago, was persuaded of the significance of the patient's

mental attitude and of the value of mental treatment for many nervous

and mental diseases:



An intimate acquaintance with human nature and with the character in

general of melancholics must always point out the urgent necessity of

forcibly agitating the system, of interrupting the chain of their

gloomy ideas, and of engaging their interest by powerful and

continuous impressions on their external senses. Wise regulations of

this nature are considered as having constituted in part the

celebrity and utility of the priesthood of ancient Egypt. Efforts of

industry and of art, scenes of magnificence and of grandeur, the

varied pleasures of sense, and



the imposing influences of a pompous and mysterious superstition, were

perhaps never devoted to a more laudable purpose. At both extremities

of ancient Egypt, a country which was at that time exceedingly

populous and flourishing, were temples dedicated to Saturn, whither

melancholics resorted in crowds in quest of relief. The priests,

taking advantage of their credulous confidence, ascribed to miraculous

powers the effects of natural means exclusively. Games and recreations

of all kinds were instituted in these temples. Beautiful paintings and

images were everywhere exposed to public view. The most enchanting

songs, and sounds the most melodious "took prisoner the captive

sense." Flowery gardens and groves, disposed with taste and art,

invited them to refreshment and salubrious exercise. Gaily decorated

boats sometimes transported them to breathe, amidst rural concerts,

the pure breezes of the Nile. Sometimes they were conveyed to its

verdant Isles, where, under the symbols of some guardian deity, new

and ingeniously contrived entertainments were prepared for their

reception. Every moment was devoted to some pleasurable occupation, or

rather a system of diversified amusements, enhanced and sanctioned by

superstition. An appropriate and scrupulously observed regimen,

repeated excursions to the holy places, preconcerted fetes at

different stages to excite and keep up their interest on the road,

with every other advantage of a similar nature that the experienced

priesthood could invent or command, were, in no small degree,

calculated to suspend the influence of pain, to calm the inquietudes

of a morbid mind, and to operate salutary changes in the various

functions of the system.






This gives some slight idea of the magnificent arrangement of this

famous health resort of the Greeks in which every possible care was

taken to influence the mind of the patient favorably and bring about

his cure. The buildings of the Hieron or medical institution of

Epidaurus were beautifully situated about six miles from the town of

Epidaurus in picturesque scenery and the most healthful

surroundings. There were a series of bathing houses for hydropathy.

The abatons, lofty and airy sleeping chambers with their southern

sides and open colonnade, are singularly like the open balconies of

our tuberculosis sanatoria. Every occupation of mind was provided.

There was a theatre that would seat over 10,000 people. Here the

great classic Greek plays were given with fullest effect. There was

a stadium seating about 12,000 people in which athletic events were

witnessed, finally there was a hippodrome for alt sorts of

amusements in which animals shared. Then there were the walks

through the country, sheltered paths around the grounds for

inclement weather, even tunnels for passage from one building to

another and all the influence of religion, of suggestion, of contact

with cultured priests thoroughly accustomed to dealing with all

manner of patients. No wonder the place was popular and many cures

effected.



A, South Propylaea; B, Gymnasium; C, Temple of Esculapius; DD, East

and West Abatons (temple enclosures); E, Pholos; F, Temple of

Artemis; G, Grove; H, Small Altar; I, Large Alter; J, South

Boundary; K, Square (building); L, Baths of Esculapius; M, Gymnasium

and Hostel; N, Four Quadrangles (for promenade and exercise); O,

Roman Building; P, Roman Bath; Q, Portico of Cotys; R, Northeastern

Colonnade; S, Northeastern Quadrangle; T, Temple of Aphrodite (?);

U, Northern Propylaea, on the Road to Epidaurus; V, Roman Building;

W, Northern Boundary; X, Stadium; Y, Goal or Starting Line; Z, Tunnel

between Temple and Stadium. (Caton.)









There are other phases of Egyptian medicine which serve to show us how

early many of the psychological ideas that we now are trying to adopt

and adapt in medicine had come to the thinkers in medicine of long

ago. There is, for instance, now in the Berlin museum an interesting

papyrus of the Middle Kingdom, the date of which is about 2500 B. C,

in which there are many modern ideas. It is a dialogue which attempts

the justification of suicide. The principal speaker, a man weary of

life, has made up his mind to suicide, but is hesitant. The others who

speak in the dialogue are his secondary personalities. The Egyptians

considered that there were several of these interior persons with whom

the man himself might have communication. A man could play draughts

with his ba somewhat as we play solitaire. He could talk to and

exchange gifts with his ka. He could argue and remain at variance,

but more often come to an agreement, with his khou. This last was

his luminous immortal ego, which, according to the then generally

received Egyptian conception, formed a complete and independent

personality. The whole scene thus outlined is typically modern in

certain phases of its psychology, and presents the only known

treatment for the tendency to suicide. While we have but this

instance, there seems no doubt that the same system of persuasion must

have been employed for the cure of other mental conditions than that

which predisposes to suicide.



What is described in our quotation from Pinel as the most ancient form

of psychotherapy has all down the centuries been the rule of life for

patients at institutions similar to those of Egypt. We know more of

Greece than of other countries; there the shrines of AEsculapius were

in many ways what we now call sanatoria. They were spacious buildings

pleasantly situated, the hours of rising and of rest were definitely

regulated, the patients' minds were occupied with the details of the

cure, they met pleasant companions from distant places, they had all

the advantages of diversion of mind, simple diet, long hours in the

open air and abundance of rest away from the ordinary worries of life.

Besides, there had usually been some weeks or months of

preparation during a lengthy journey and all the diversion of mind

which that implies. No wonder that these institutions acquired a

reputation for cures of symptoms which the physician had been unable

to accomplish while the patient was at home in the midst of his daily

cares and worries of life.



The temples in Egypt, in Assyria, in Greece, were much like the health

institutions--"cure houses," as the expressive German phrase calls

them--of our day. Pictures of the temple of AEsculapius at Epidaurus

show a magnificent building with beautiful grounds, ample bathing

facilities, and evidently many opportunities for a quiet, easy life

far from the worries and bustle of the world and with everything that

would suggest to the patient that he must get well. This phase of

psychotherapy in the olden time is not only interesting in itself, but

furnishes a valuable commentary on corresponding modern institutions,

since it shows that it is not so much the physical influences, which

have differed markedly at different periods, as the mental attitude so

constantly influenced at these institutions which was the real

therapeutic factor.



Now our sanatoria are nearly all founded on some special principle of

therapeutics. Some of them have dietetic fads and no food out of which

the life has been cooked is eaten. Some of them are absolutely

vegetarian. Some of them depend on wonderful springs in their

neighborhoods, others on certain forms of exercise, still others give

the rest cure. All succeed in relieving many symptoms. No one who has

analyzed the cures effected will think for a moment that it is the

special therapeutic fad of the institution that accomplishes all the

good done for patients suffering from so many different complaints.

Similar ills often are affected quite differently, and, while some are

relieved, others are not. Those who fail to be cured at one will,

however, often be relieved at another. It depends on how much

influence of mind is secured over the patient and how much diversion

from thoughts of self is provided.