Medicine, Culture, and Self in Late Antiquity: A Gastronomic Reflection

While doing research on slavery in late ancient Christian thought, particularly in Syria and Mesopotamia, I came across this statement in John Chrysostom’s (349–407 CE) Homily 13 on Philippians 2: “You have received a stomach, that you may feed, not distend it, that you may have mastery over it, not have it as a mistress [despoinan] over you, that it may serve you for the nourishment of the other members, not that you may minister to it, not that you should exceed its limits.”[i] Some time later, I was reading Philoxenus of Mabbug’s (440–523 CE) Discourse 10 On Gluttony 26 (Kitchen, 294), and came across something very similar: “This is the wage their gluttony gives to them, for they are also worthy to receive this reward from that mistress [martā] of iniquity who they serve,” and Philoxenus lists diseases of the hands and feet, tumors and ulcers, tremors, digestive problems, sleep disorders, sneezing, chronic hiccups, and much more. Chrysostom provides a similar list (see, for instance, Homily 39 on 1 Corinthians 9). Most importantly, both Chrysostom and Philoxenus highlight diseases of the soul, caused by gluttony, along with physical ailments.

The important studies of Aline Rousselle[ii] and Teresa Shaw[iii] have already broadened our understanding of how diet influenced sexuality in antiquity. But I want to go even deeper to the issue, to the very level of strategic constructions of anatomy and physiology that inform ancient medical frameworks that produce the type of discourses, sexual and others, highlighted by Rousselle and Shaw. What is intriguing about such statements as cited above—and one can list many similar cases with other authors—is that in them we witness how health, physiology, and anatomy are structured by means of social and cultural discursive formations. In this case, the discourse of slavery, which I have termed doulology,[iv] structures the dynamics between mental and gastric health. By their extension into the realm of the material psychē, these dynamics, in turn, shape the self. You are how you eat.

To briefly illustrate the complex relationships and interactions between medicine, culture, and self in late antiquity, we may examine and elaborate on Chrysostom’s statement about the stomach cited above. Late ancient medical thinking was particularly influenced by Plato’s notion of the tripartite self, in which the rational soul resides in the brain, the vital soul in the heart, and the appetitive soul in the liver.[v] Anatomically, the passions were supposed to be segregated from one another. The diaphragm separated the appetitive from the vital, and the neck was the barrier that had to safeguard the rational soul in the brain. Galen (129–216/17 CE), whose medical knoweldge was extremely influential in the late antique East, subscribed more or less to this triangular division of the human self. But there was one problem, an inconvenient link between the stomach and the brain: the vagus nerve (historically also known as the pneumogastric nerve). In Galen’s fourteenth book On Anatomical Procedures (chapter 10; Duckworth, 220), which delineates the cranial nerves, he explains: “And when the vagus has travelled further with the oesophagus [which it encircles],the vagus joins the mouth [oesophageal orifice] of the stomach and infiltrates it, so that this part attains such a high degree of nervous sensibility and of relationship with the components of the nervous system that it is pre-eminent above all the other bodily parts in this respect, and for this reason it possesses a surplus of sensitiveness.” The image above provides us with a helpful view of the breadth of the vagus nerve (in yellow).

The stomach connects to the brain and the heart via the vagus nerve, while the “great artery” also joins the stomach and the heart. We therefore have a “rival triangle” to that of the brain, heart, and the liver.[vi] The problem is that the brain has less control over the stomach than, for instance, the liver. The brain can influence the stomach, but the stomach can also influence the heart. The late ancient bishop and medical author, Nemesius of Emesa, explained it thus: “This part of the non-rational part [i.e. the nutritive faculty, which includes the mouth, stomach, abdomen, liver, veins, intestines, bladder, and the kidneys] is said not to be capable of obeying reason since it carries out its specific work not according to our judgement [gnōmēn] or choice [proairesin], but naturally [physikōs]” (On the Nature of the Man 23.84.22–24; Sharples & Van der Eijk, 150). As with Nemesius here, Chrysostom and Philoxenus constantly note the corrupt mindset and will as the cause of gluttony.

This mutual influence becomes problematic when humors and vapors rise from the stomach to the brain, which can impair an individual mentally according to ancient thought. The stomach and surrounding parts of the nutritive division have the ability to act as a dominating force against the brain—the anatomical equivalent of a peasant or slave revolt. Chrysostom warns: “Because of the heat of fermentation [in the stomach], noxious vapours are sent forth all over the body, as if from an oven. And if people outside are disgusted [by the belching], what do you think the brain suffers inside, overpowered by these fumes? And what about the channels of the heated and obstructed blood? And what about those reservoirs, the liver and the spleen, and of the canals by which the excrement is discharged?” (Homily 13 on 1 Timothy 4). One must eat “not so as to distend the stomach, or to cloud the reason” (Chrysostom, On the Statues 9.1). Philoxenus writes: “Just as thick fog and smoke disturb the pure and clean air, so also the vapour of food agitates the clarity of the intellect” (Discourse 10.49; Kitchen, 313). Mental health and illness are explicitly related to diet.

The stomach thus has the capacity to enslave the self, making one a “slave to the stomach” (gastridoulos). But both Chrysostom and Philoxenus construct gastric enslavement within a very specific doulological category, namely domestic slavery. The stomach is not simply a master, but it is a female slave master, or a mistress (Grk: despoina; Lat: domina; Syr: martā). The doulological discourse of gluttony is a pervasively gendered discourse. While the practice of self-control and moderation is an attribute of masculinity, being dominated by the stomach is seen as a shamefully effeminate position. Chrysostom’s gastridouloi are then no different from those he labels gynaikodouloi, the “slaves of women,” in his treatises against the subintroductae. If the mind and will are unable to exert dominance over the stomach, then external measures are required. Thus, when physicians and homilists provide dietary regulations, they assume the position of the brain in attempting to control the stomach. By controlling their patients’ or audience’s diet, they fashion not only the masculinity of the hearers, but also their own masculinity, by assuming an active and dominating position. Helen King rightly notes: “[T]he sick role is feminized, while the doctor embodies what are considered to be the masculine virtues.”[vii] Thus we see the power dynamics between medicine and medical discourse, culture, and the shaping of the (gendered) self.

As a methodological lens, ancient medicine and healthcare studies have the potential to enable us to understand the cultural construction of society and self in late antiquity.[viii] Ancient social values of responsibility, agency, self-control, but also notions of class and gendered identity are informed by medical discourse and reinscribed by it. By delineating physiology and anatomy in gendered doulological terms, for example, the values of an androcentric slaveholding society become more potently ratified. Moreover, for both Chrysostom and Philoxenus, the pathology of gluttony and, by implication, obesity, is not only physiological, but related to the subject’s unwillingness (it is, indeed, a problem of will power) to exercise rational control and choice.

For Chrysostom and Philoxenus, a gluttonous person is blameworthy because of this person’s lack of self-control. Since gluttony becomes a matter of agency, such a person should either be corrected or socially marginalised. In contrast to gluttony, Chrysostom also speaks of people suffering from ancient bulimia (boulimia[ix]): “Of physical diseases this one is thought a most agonising one, and it is called by physicians bulimia, when a person being filled, remains always hungry” (Homily 7 on 2 Timothy 2).[x] Bulimia in its ancient sense should not be confused with modern-day bulimia nervosa, an emotional eating disorder.[xi] In ancient medical discourse, many thought bulimia to be a disease characterized by excess heat in the body. The more food and drink consumed, as with a furnace, the hotter the body burns and the hungrier it becomes.[xii] Because it is seen as a physical illness, the person suffering from ancient bulimia is not afforded blame for their condition, only pity. There is indeed some pathologization in both cases, but the pathologization of bulimia and gluttony is appropriated differently and has different ends in mind. But with gluttony it is the individual’s fault alone. Interestingly enough, both Chrysostom (in Homily 35 on Acts 3) and Philoxenus (Discourse 10.7) also refer briefly to “naturally big” persons, who should not technically be treated as if they are gluttons.

The problem is that the distinctions between “self-inflicted” diseases (e.g. gluttony) and “involuntary” diseases (e.g. ancient bulimia) are artificial and academic at best. At first sight, how would one determine whether an overweight person suffers from bulimia or partakes in gluttony, or simply naturally avoirdupois? For example, Theodoret of Cyrrhus relates the following incident: “The wife of a nobleman fell ill of morbid gluttony [adēphagias]; some called the illness a demonic attack, others thought it a sickness of the body. Whether the former or the latter, it was like this: they used to relate how, though eating thirty chickens a day, she could not by surfeit extinguish her appetite but hungered for still more of them” (History of the Monks of Syria 13.9; Price, 103). Theodoret is unsure whether the woman’s problem is physiological—that is, whether she is suffering from bulimia—or whether it is excessive gluttony because of a demonic attack. Whichever it might be, the treatment is the same. The monk Macedonius prays over some water, making the sign of the cross over it, and gives it to her to drink. The holy medicine then heals her despite the lack of an aetiology for her illness.

“Wars” (note the explicit masculine militaristic term) against gluttony and, in effect, obesity, ancient and modern, inevitably function as moral discourses that are structured according to a subconscious culture of blame. And overweight persons are often pathologized by default. Allow me to turn to a modern example to illustrate this point. Several years ago a famous U.S. journalist and advocate of LGBTI rights, Dan Savage, was accused by a colleague of “fat-shaming.” In a book written by Savage, in which he advocated for gay rights (especially gay marriage), he remembers going to a water park in Sioux Falls, South Dakota. Savage writes that “owners of water parks in the U.S. must be saving a fortune on water and chlorine bills,” apparently because of the water displacement resulting from obese persons floating in the pools.[xiii] Savage was very outspoken about obesity and weight loss, and he made a point of emphasizing the role of individual agency and choice in the “obesity epidemic.” According to Savage’s view, obesity could be overcome by voluntary and healthy lifestyle changes. What is more, in a column Savage wrote in 2011, he argued that if the state of Iowa decided to ban gay marriages because some anti-gay activists saw gay marriage as a threat to public health, then the state should also ban the marriages of obese persons for similar reasons. Savage writes:

Even if it were true—even if gay people had lower life expectancies (which we do not)—and if that ‘fact’ all by itself was a justification for banning same-sex marriage, why stop with gay people? Iowa should ban fat marriage. There are, according to the state of Iowa, more than 1.4 million obese people living in Iowa. That’s nearly 30% of the state’s population, and those numbers just keep rising. The social costs of Iowa’s obesity epidemic are pretty staggering—and those costs include including [sic] premature death and lower average life expectancies for Iowans.

According to this logic, since obesity is ‘contagious’—someone with an obese spouse is 37% more likely to be or become obese—then we shouldn’t permit the obese to marry. If an outright ban on fat marriage seems too draconian, then we shouldn’t permit the obese to marry the non-obese. The odds that the skinny spouse will be ultimately be [sic] seduced into the risky obese lifestyle are simply too great and the potential health consequences too severe.[xiv]

Savage’s is of course a reductio ad absurdum; he is not advocating for the actual banning of obese marriages. He rather wants to illustrate that banning gay marriage on medical grounds would be as ludicrous as banning the marriage of overweight persons. Yet he still appropriates a discourse of pathologization on obese persons in precisely the same way as his opponents pathologized gay individuals. The only difference, according to Savage himself, is that his example was actually true and factual.

Lindy West, a colleague of Savage, wrote about her experience of his anti-fat rhetoric in her own book; she also elaborated on the experience during a public radio interview.[xv] West says:

[Dan Savage] was on something of an obesity epidemic kick. He wasn’t alone. The rest of the nation had declared a war on obesity. They’d whipped up a host of reasons why it was right and good to hate fat people—our repulsive, unsexy bodies, of course, the classic, but also our drain on the health care system, our hogging of plane armrests, our impact on ‘the children,’ our pathetic inability and/or monstrous refusal to swap austerity for gluttony, oh, and our health, because they care.

While at face value the moral frameworks of Savage and his opponents differ radically, they bothuse the moral discursivities of a blame culture, such as pathology (medical/social/economic/moral), truth, danger, agency, and rest, in the same way. The culture of stigmatization and blame remains. In his attack on fat, Savage proved that he was willing to “hypothetically” pathologize and abnormalize one group of individuals (obese persons) in favour of de-pathologizing and normalizing another (LGBTI persons). Nothing is done to cultivate a culture of tolerance, acceptance, guidance, and holistic healing.

A sensitivity to “medical readings” of ancient culture-making and subjectivation may also assist us in better accounting for and critiquing harmful discourses in current debates about health, wellness, and the gendered self. In my work on obesity in late antiquity,[xvi] as well as aging and old age,[xvii] I hope to contribute to this important scholarly mandate.

Chris L. de Wet is Associate Professor of New Testament and Early Christian Studies in the Department of Biblical and Ancient Studies, at the University of South Africa, Pretoria. He is the author of Preaching Bondage: John Chrysostom and the Discourse of Slavery in Early Christianity (University of California Press, 2015), and The Unbound God: Slavery and the Formation of Early Christian Thought (Routledge, 2018). He is also the editor of the Journal of Early Christian History (Routledge).

[i] All Chrysostom translations are my own.

[ii] Aline Rousselle, Porneia: On Desire and the Body in Antiquity, trans. Felicia Pheasant (New York: Barnes & Noble, 1996).

[iii] Teresa M. Shaw, The Burden of the Flesh: Fasting and Sexuality in Early Christianity (Minneapolis, MN: Fortress, 1998).

[iv] Chris L. de Wet, Preaching Bondage: John Chrysostom and the Discourse of Slavery in Early Christianity (Oakland: University of California Press, 2015), 1–44, 282; The Unbound God: Slavery and the Formation of Early Christian Thought, Routledge Studies in the Early Christian World (London: Routledge, 2018), 1–39.

[v] The work Wendy Mayer and Antigone Samellas is very helpful in understanding bishops as physicians of the soul; Wendy Mayer, “The Persistence in Late Antiquity of Medico-Philosophical Psychic Therapy,” Journal of Late Antiquity 8.2 (2015): 337–51; “Medicine in Transition: Christian Adaptation in the Later Fourth-Century East,” in Shifting Genres in Late Antiquity, ed. Geoffrey Greatrex and Hugh Elton (Farnham: Ashgate, 2015), 11–26; Antigone Samellas, Death in the Eastern Mediterranean (50-600 A.D.): The Christianization of the East: An Interpretation, Studien und Texte zu Antike und Christentum 12 (Tübingen: Mohr Siebeck, 2002), 70–115.

[vi] Brooke Holmes, “Disturbing Connections: Sympathetic Affections, Mental Disorder, and the Elusive Soul in Galen,” in Mental Disorders in the Classical World, ed. William Harris, Columbia Studies on the Classical Tradition 38 (Leiden: Brill, 2013), 169–70.

[vii] Helen King, Hippocrates’ Woman: Reading the Female Body in Ancient Greece (London: Routledge, 1998), 1.

[viii] Theoretically, a good place to start is with works of Georges Canguilhem, The Normal and the Pathological, trans. Carolyn R. Fawcett (New York: Zone, 1989); and Michel Foucault, History of Madness, ed. Jean Khalfa, trans. Jonathan Murphy and Jean Khalfa (London: Routledge, 2006); The Birth of the Clinic (London: Routledge, 1989). On late ancient “knowing” and medicine, the exploration of Heidi Marx-Wolf, “Medicine,” in Late Ancient Knowing: Explorations in Intellectual History, ed. Catherine M. Chin and Moulie Vidas (Oakland: University of California Press, 2015), 80–98 is indispensible.

[ix] See also phagedaina; and the opposite, anorexia.

[x] See also Homily 1 on 2 Thessalonians 2.

[xi] Persons suffering from modern bulimia nervosa often have a distorted view of their bodies and exhibit an obsession to avoid weight gain. Bulimia nervosa is characterised by bouts of binge eating followed by extreme measures to avoid gaining weight, such as vomiting and fasting.

[xii] On the nature of bulimia in antiquity, see Plutarch, Convivial Questions 6.8.1–6 (LCL 424.492–505).

[xiii] Dan Savage, The Commitment: Love, Sex, Marriage, and My Family (New York: Dutton, 2005), 18.

[xiv] Dan Savage, “Ban Fat Marriage,” The Stranger, February 10, 2011, http://www.thestranger.com/slog/archives/2011/02/10/ban-fat-marriage (accessed 13 April 2017); my italics.

[xv] Lindy West, Shrill: Notes from a Loud Woman (New York, Hachette, 2016), 86–107; for the This American Life radio interview with Ira Glass (“Tell Me I’m Fat”) and its transcript, see https://www.thisamericanlife.org/radio-archives/episode/589/transcript (accessed 13 April 2017). I refer here primarily to the radio interview.

[xvi] Much what is written in this article will appear, in a more unabridged form, in Chris L. de Wet, “Gluttony and the Preacher’s Diet: Regimen, Obesity, and Psycho-Somatic Health in the Homilies of John Chrysostom,” in (Re)Visioning John Chrysostom: New Theories and Approaches, ed. Chris L. de Wet and Wendy Mayer (Leiden: Brill, 2017), Forthcoming. I thank Wendy Mayer for her insights in this research.

[xvii] Chris L. de Wet, “Grumpy Old Men? Gender, Gerontology, and the Geriatrics of Soul in John Chrysostom,” Journal of Early Christian Studies 24.4 (2016): 491–521.