This monograph contributes to the growing body of research into the relation between late antique Christian asceticism and Graeco-Roman medicine by exploring how medical paradigms and practices were pressed into the service of monastic spiritual direction by Basil of Caesarea, Evagrius of Pontus, John Cassian and John Climacus.
A comprehensive introduction explains the book's rationale and plan, situates it in relation to contemporary scholarship, outlines the nature of spiritual direction in early Christian monasticism, and introduces its protagonists: Galen of Pergamon (the physician who exerted the greatest influence on Christian writers), Basil, Evagrius, Cassian and Climacus. It then divides into two parts, the first and longer of which, ‘Logics of Practice’, focuses on how Evagrius, Cassian and Climacus incorporate medical themes into their instructions for spiritual directors. Z. begins by introducing the hermeneutical framework through which he reads the sources, that of biopsychosocial (BPS) models of health and illness. Like Graeco-Roman medicine, but in contrast to modern Western biomedicine, BPS perspectives situate health and sickness at the convergence of physical, psychological and social or ecological dimensions. Chapter 1 then comprises an introductory overview of Galenic medical theory and practice.
In Chapter 2 we meet the first of Z.'s four monastic authorities, Evagrius, to see how he uses dreams to diagnose the state of the soul. Z. shows how, while Evagrius’ interest in the significance of dream imagery is indebted to medical theory in both its background and its purpose and his understanding of dream production is Aristotelian, he locates the diagnostic value of dreams in their aetiology. While dreams can be sent by angels, they are more usually sent by demons, and while not in themselves morally culpable, they reflect the dreamer's psychophysical disposition and thus their choices, for example those who indulge in anger are prone to nightmares. Chapter 3 is the first of three devoted to Evagrius’ disciple John Cassian. While agreeing with Evagrius as to the diagnostic utility of dreams, Cassian departs from him by denying that dreams can ever be sources of true information or insight, by focusing only on sexual dreams, and by attending at length to nocturnal emissions: whereas Evagrius notes simply whether or not they are accompanied by images and that, if they are, the quality of the images are indices of the soul's health, Cassian devotes roughly ten percent of his writings to them. He does so, Z. explains, because he ‘sees in ejaculated semen the body's confession, whether of dietetic imbalance, of mental wandering, or of demonic warfare’ (p. 112). Chapter 4 widens the focus to Cassian's scheme of the eight vitia. Z. introduces us to his rich psychological vocabulary with finesse, paying careful attention to the meaning of key terms and Cassian's sometimes idiosyncratic usage and explaining how he expands upon Evagrius’ eightfold classification of evil thoughts and relates the vitia to the tripartite soul to produce a detailed taxonomy of passions. Chapter 5 introduces John Climacus’ understanding of and approach to diagnosing and healing the passions. Whereas for Cassian the passions are ‘excessive and/or passively experienced motions of soul and body’ that can be either ‘momentary’ or, through habitual indulgence, ‘become dispositional’, John reserves the term pathos for dispositional states (pp. 164–5), and while he shares Cassian's interest in medicine and medical imagery, he rejects a systematic taxonomy in favour of situating the pathe within dynamic flows stemming from single precipitating causes such as the innumerable passions to which indulging the stomach's insatiability gives rise.
The second part of the book, ‘Representations’, focuses on how monastic writers portray spiritual directors as physicians to signal the overlap and mutual entanglement of bodily and psychological healing, echoing the fact that physicians such as Galen ‘operated on souls as well as bodies, and moral philosophers relied on medical techniques of dietetics to cultivate moral habits’ (p. 201). Chapter 6 introduces the section by describing how physicians operated in the diverse medical ecosystems of late antiquity. Chapter 7 focuses on Basil's portrayal of the monastic superior as a physician of souls who situates physical symptoms and medical remedies within a teleological vision of the Christian life. Chapters 8 and 9 return to Cassian and Climacus to explore how the monastic elder as spiritual physician assumes the additional roles of teacher, judge and for Climacus also shepherd, as circumstances require. A particularly striking observation is that, for Cassian, a key difference between the spiritual director and the Galenic physician is that ‘experience of suffering is essential to the former but not to the latter: for Cassian, it is possible to know the “correct remedies” even for passions one has not experienced, but it is not possible to maintain the correct bedside manner, or compassion and humility, without having suffered oneself’ (p. 272). This is equally true of Basil, Evagrius and Climacus, being an instance of the monastic axiom that, in order to rise with Christ into virtue, we must first die with him through suffering.
Finally, ‘Conclusions and Prognoses’ summarises the book's findings, reflects upon the consequences for the subsequent practice of spiritual direction by portraying it in medical terms and considers future directions for research.
This book has many virtues. The BPS hermeneutic pre-empts reading its protagonists through an anachronistic dualistic lens, the background material on Galenic medicine is well judged, and the chapters on Cassian and Climacus are excellent. In comparison to Cassian and Climacus, Evagrius fares less well. While Z.'s decision to limit his discussion to his dream diagnostics was perhaps motivated by the fact that, as he rightly notes, ‘Evagrius’ works present both linguistic and conceptual problems for modern readers’ (p. 13), this reviewer would have liked to see it contextualised by reference to his wider use of medical imagery (cf. especially L. Dysinger, Psalmody and Prayer in the Writings of Evagrius Ponticus [2005], Chapter 4), the dream that precipitated his flight from Constantinople and led him to conclude that dream agency is real (having sworn an oath in the dream, he wondered upon waking whether it was binding and decided it was), and Melania's role as confessor-physician in diagnosing the mysterious illness that afflicted him in Jerusalem and identifying as its cure that he embrace the monastic life, which he duly did (Palladius, Lausiac History 38.4–9). Not only do the two Palladian vignettes (attributed by Palladius to Evagrius) support the book's thesis, but the latter shows how the role of confessor-physician could subvert conventional hierarchies of both gender and age, Melania being some five years younger than Evagrius.
On the editorial side, several typographical errors slipped through the net. Most are insignificant, but it is vexing to read on p. 148, ‘In the following quotation, underlined portions are shared verbatim with Aristotle’ when none of the quotation in question (from Evagrius, Praktikos 89) is underlined, and it is surprising to learn on p. 261 that for Cassian ‘the monk seeking purity of heart does wander peradventure’ until the continuation of the sentence, ‘instead following the path the elders have carved out’, clarifies that ‘does’ is a gatecrasher. I resorted to Google to identify the well-placed quotation from Eliot's Four Quartets on p. 127.
In all other respects the book is produced to OUP's usual high standards. The many helpful figures and tables include Galen's taxonomy of arts, Galen's symptomology by function and by temporal reference, Evagrius’ oneiric symptomology, Cassian's diagnostics of nocturnal emissions and several of Climacus’ genealogies of passion. An index of select ancient authors with detailed topic references is supplemented by a subject index, an index of select modern authors, and indexes of Greek and Latin terms. The bibliography is wonderfully extensive in respect of both primary and secondary sources. The literary references dotted throughout the book are an enjoyable bonus.
This is a groundbreaking study that will be of interest to historians and practitioners of spiritual direction, monasticism, spirituality, medicine and psychology.
