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The Lancet, Volume 383, Issue 9921, Pages 946 - 947, 15 March 2014
doi:10.1016/S0140-6736(14)60471-2Cite or Link Using DOI

Narratives of healing: a new approach to the past?

Helen King aEmail Address
Aelius Aristides (117—180 AD) was a successful orator from Asia Minor at the height of the Roman Empire; he travelled widely and visited Rome itself. His job was highly competitive, and included public performance of the lengthy and complex speeches he wrote. These would be delivered before very large audiences; the events have been described by modern scholars as the equivalent of football matches. Many of these speeches honoured particular cities, marking occasions such as the visit of an emperor or a special anniversary, and displayed a thorough knowledge of much earlier Greek literature and language—part of a wider admiration for the Greek past in second-century AD Roman culture. Among the works of Aelius Aristides, however, there is something rather different: Hieroi Logoi, usually translated as Sacred Tales. These recount his various illnesses, which he interpreted in a positive way, as giving him opportunities to develop his intense personal relationship with the healing god Asklepios, on whom he learned to rely.
In the long history of interaction between medicine and the arts and humanities, the Hieroi Logoi have been responsible for Aelius Aristides getting a bad press. At least since the tenth century AD, his obsessive interest in his bodily experiences has led to a series of derogatory labels, and he has been retrospectively diagnosed with whatever happened to be fashionable at the time. Habitually called a hypochondriac, from the late 18th century onwards, he has been dismissed by scholars as in turn narcissistic, neurotic, hysterical, or neurasthenic: he has been labelled a freak, or a lunatic.
Part of this history of distaste comes from the sheer detail of his descriptions of his symptoms. At one time Aelius Aristides' illness seems to have been predominantly respiratory, and at a later period mostly gastrointestinal. He also had seizures, writing that “My body was drawn in all directions: my knees were borne upwards to my head, and dashed against it, it was impossible to control my hands, but they beat against my neck and face” (Hieroi Logoi 3.17). On many occasions Aelius Aristides provides just too much information: who really wants to hear the details of his enemas, or his sensation that his intestines “were cold and hanging out”? Unperturbed by the disgust felt by some readers, Aelius Aristides goes on telling us all the details. He describes a similarly wide range of treatments proposed by Asklepios, who spoke to him in dreams; these included cold baths, highly restricted diets, and running round temples covered in mud.
Aelius Aristides is one of the most famous patients of antiquity, but how do his stories of his body interact with the growing contemporary interest in narrative medicine? Rita Charon has written that “Sick persons and those who care for them become obligatory story-tellers and story-listeners”. The last decades of the 20th century saw an upsurge in life writing, including autosomatography (writing about one's own body, a genre potentially including not just illness memoirs but also those about disability) and autopathography (which implies the condition is a pathos, the ancient Greek word often translated as “disease”). Many of these medical forms of life writing emerged after Susan Sontag's Illness as Metaphor (1978), which grew from her own experiences of breast cancer.
In the 21st century, our hunger to tell our story and to hear those of others still seems to be growing, partly because of the internet. The Healthtalkonline website, for example, offers the user interviews, arranged by medical condition, which often include video or audio. The site currently opens with a quotation from the author Philip Pullman, that “True stories are…nutritious and sustaining. They feed the mind with information and the heart with hope and strength.” Stories have heroes, and some people who choose instead to blog about their experience of illness frame this in upbeat ways, casting themselves as super-patients; but Healthtalkonline focuses on ordinary, non-heroic fellow sufferers. Another website, Jeffrey Aronson and Rachel Hall-Clifford's Patients' Tales, takes a different approach, focusing on published books written by patients about their illnesses or conditions. It lists more than 300 works, and includes Aelius Aristides, listing him under chronic health issues—which seems an entirely reasonable decision—and, within this, in the subcategory of “Ill health”. This method thus resists any retrospective diagnosis whatsoever. So if the modern reader avoids diagnosing this story-telling patient of the past, what can narrative medicine say to him, and he to it?
In the last few years there has been an upsurge in publications on Aelius Aristides. Scholarship on him is now concentrating on his cultural and historical context, seeing this very much as a story of its time, and not something unique and bizarre. More broadly, reading Aelius Aristides should make us think more about who writes an autopathography, what their background and expectations are, and how they went about doing it. Even though generations of scholars have accepted the Hieroi Logoi as a transparent account that gives direct access to a real person's experiences, we need to be cautious in reading this work in such a way, and should take the same care when reading a modern patient's account. Although often labelled by scholars as “dream diaries”, the Hieroi Logoi that survive are neither diaries nor notes, but polished pieces of prose. They were committed to writing over 10 years after the illnesses Aelius Aristides describes, and produced from his home in Mysia, not from the temple of Asklepios in Pergamum where he spent so much time while he was most seriously ill. Perhaps, as Aelius Aristides himself suggests, there really were earlier “diaries” composed at the urging of the god, from which the surviving version was developed. But we cannot know.
The title itself is interesting. Scholars have commented that the English translation, Sacred “Tales”, is perhaps a little dismissive. In the original Greek, however, the title situates these works in what was an established literary genre, the hieros logos, an account of the epiphany of a god to his worshippers. So, in terms of the intended audience, rather than writing an autopathography for fellow sufferers, Aelius Aristides may well have seen his account as a votive offering to the god Asklepios, equivalent to the inscriptions and images of body parts found at that god's sanctuaries.
Yet the points of familiarity to later readers of the Hieroi Logoi still remain powerful today. Aelius Aristides wanted an explanation for his pain, but the physicians could not give him one. They tried to interpret his body, but it was mainly the god who interpreted the other part of his experience that, for him, revealed the truths of that body, namely his dreams. Medicine and religion were not separated either in terms of space or in terms of culture: there were physicians at the temples of Asklepios, and Asklepios was seen as the inventor of medicine. Aelius Aristides documents the value he found from consultations with these physicians as well as his religious experiences. These experiences were mostly the dreams sent to him by his god. In the ancient world, physicians also regarded dreams as providing them with useful information about their patient. Even the terminology of religion and medicine was not always distinct at this time; for example, both priests and physicians talked about katharsis or purging/cleansing and the patient could choose to interpret what was happening according to his personal preferences.
Do Aelius Aristides' cultural assumptions about the links between the medicine of physicians and that of Asklepios, and the value of combining the two, suggest the distance between then and now, or do modern patients still function with beliefs about, for example, their dreams that they may not share with their physicians? What models do patients use to make sense of their experiences when medicine does not currently have an answer? The search for meaning is not the only point of contact between this ancient patient and modern narrative medicine. The images of storms and journeys that Aelius Aristides used as ways to make sense of his suffering are also familiar from modern autopathographies, but in his own context the journey image would have resonated strongly—and sometimes explicitly—with Homer's Odyssey and could, therefore, be seen as a way of consciously displaying his familiarity with the great works of Greek literature. Aelius Aristides also represents life as a drama in Hieroi Logoi; again, a key form of ancient literature. At one point, he dreams of being an actor at the end of a performance. When he turns to face the wall, Asklepios makes him turn back to face the room. He describes what seems to be an almost out-of-body experience, writing, “I was aware of myself just as if I were someone else, and I perceived my body ever weakening until I came to the end”. In reading the narrative of this ancient patient, the contemporary reader oscillates between distance and familiarity.
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Full-size image (115K) Hervé Champollion/akg-images
Votive relief of Asklepios
Narrative medicine encourages us to see Aelius Aristides as making sense of his life through constructing a story in which he is the hero, favoured by the god of healing, and this is helpful in enabling classical scholars to avoid the temptation of interpreting his descriptions as raw experience. The Hieroi Logoi provide a rare example of an ancient patient's description of his suffering, and his attempt to create meaning out of it, using existing models of epic and dramatic writing to make himself no ordinary patient. While this approach encourages us to address the literary elements of this historical patient's writing, any sense of familiarity must always be held in tension with an understanding of the very different context within which a second-century elite writer decided to compose an account of the god's interventions in his life. Although attending to the narrative can offer a better route than retrospective diagnosis in understanding certain accounts of illness from the past, it too must be used with care.
For healthtalkonline see
For the Patients' Tales see

Further reading

Aronson, 2000 Aronson JK. Autopathography: the patient's tale. BMJ 2000; 321: 1599-1602. PubMed
Behr, 1968 Behr CA. Aelius Aristides and the Sacred Tales. Amsterdam: Hakkert, 1968.
Charon, 2005 Charon R. Narrative medicine: attention, representation, affiliation. Narrative 2005; 13: 261-270. PubMed
Downie, 2013 Downie J. At the limits of art: a literary study of Aelius Aristides' Hieroi Logoi. New York: Oxford University Press, 2013.
Harris and Holmes, 2008 In: Harris WV, Holmes B, eds. Aelius Aristides between Greece, Rome, and the gods. Leiden: Brill, 2008.
Israelowich, 2012 Israelowich I. Society, medicine and religion in the Sacred Tales of Aelius Aristides. Leiden: Brill, 2012.
Petsalis-Diomidis, 2010 Petsalis-Diomidis A. “Truly beyond wonders”: Aelius Aristides and the cult of Asklepios. Oxford: Oxford University Press, 2010.
a Department of Classical Studies, Faculty of Arts, The Open University, Milton Keynes MK7 6AA, UK
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