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Llkantropija U RADOVIMA VIZANTIJSKIH LEKARA

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Llkantropija U RADOVIMA VIZANTIJSKIH LEKARA Psihijat. dan. /2005/37/2/323-327/ 323 Kontaksakis P. V. Likantropija u radovima vizantijskih lekara Strucni rad UDK 616. 89 - 008 (495.02) 616. 89 (091) LlKANTROPIJA U RADOVIMA VIZANTIJSKIH LEKARA Vasitis P. Kontaksakis', tDzon G. Laskaratos", Panajotis P. Ferentinos', Maria-Irini V. Kontaksaki', Dzordz N. HristoduJu I lKatedra za psihijatriju, Univerzitet u Atini, Grcka 2Istorija medicine, Univerzitet u Atini, Grcka Apstrakt: Svrha ovog rada je da napravi pregled tekstova 0 Iikantropiji iz vizantijske medicinske literature i da proeeni njihov utieaj na medicin u od tog perioda do danas. Proucavani su original ni tekstovi na grckorn jeziku vizantijskih lekara, kao sto su Oribas ijc (IV vek n.c.), Ecije (VI vek n.e.), Pavle Eginjan in (VII vek n.e.), Pavle iz Nikeje (VII vek n.e.), Mihajlo Psel (XI vek n.e.) i Jovan Aktuarije (XIV vek n.e.). Autori su, takode, preglcdali i sacuvane lekstovc antickih grckih i rimskih lekara. Vizantijski lekari su pruzili detaljne opise klinicke slike Iikantropije, kao i predlogc za njcno leccnjc. Smatrali su da likantropija predstavlja oblik rnelanholicne iii psihoticne depresije, a ne da je demonskog porekla, sto je u skladu sa misljcnjcm rimskog lekara Marsilija Siditskog (II vek n.e.), koji je prvi opisao ovaj sindrom . Stavovi vizantijskih lckara 0 likantropiji su neposredno iii posredno uticali na nacin na koji se arapska iii zapadnoevro pska medic ina kasni­ jc bavila tim problemom. Kljucne re ci: vizantijska medicina, istorija medicine. likantropija, depre sija, melanholi­ ja. ps ih oza 324 Psihijat. dan. /2005/37/2/323-327/ Kontaksakis P. V. Likantropij a u radovima vtzantijskth lekara Uvod Likantropija je sumanuto uverenje bolesnika da se preobrazava u zi­ votinju, pO tradiciji, u vuka [1,2]. Terminje nastao od grckih reci lyeos = vuk i anthropos = covek. Najraniji opisi ovog sindroma mogu se naci u grckoj mitologiji. Poluboga Likaona Zevs je za kaznu pretvorio u vuka, jer je poku­ sao da posluzi Zevsa mcsom zrtvovanog mladica [3]. Jedan kasniji opis ovog sindroma nalazi se i u Bibliji. U Prvoj knjizi Danilovoj, Bog je kaznio vavi­ lonskog kralja Nabukodonosora tako sto ga je na sedam godina pretvorio u vola [4,5]. Pocetkom XIX veka likantropija je smatrana dusevnim poremecajem [6]. U svetskoj literaturi je tokom XX veka objavljeno nekoliko prikaza slu­ cajeva likantropije. Vecina se odnosila na pacijente koji su patili od afektiv­ nih iIi psihoticnih poremecaja. Ostali slucajevi preobrazaja coveka u zivoti­ nju javili su se kod pacijenata sa drugim mentalnim poremecajima, medu ko­ jima su bili poremecaji licnosti, histerija, zloupotreba alkoho1a iii droga, or­ ganski mozdani sindromi, demencija i epilepsija [7-11]. Ovaj rad ima za cilj da pokaze da su radovi vizantijskih lekara 0 li­ kantropiji obezbedili nove podatke i ponudili jasnija tumacenja ovog stanja; stavi se, oni pruzaju dokaze da je likantropija od antickih vremena smatrana dusevnorn bolescu, Vizantijska medicina, u stvari, predstav1ja nastavak anticke grcke, helenisticke i rimske tradicije u medicini, kao i vaznu kariku koja je povezuje sa zapadnoevropskom medicinom na koju je uticala neposredno iii posredno, preko tekstova arapskih lekara. Proucavanje tckstova vizantijskih lekara je od velikog znacaja jer vccina njih reprodukuje sustinu radova starogrckih lekara, od kojih jc veci deo danas izgubljen, a u isto vreme, daje i svoj licni doprinos temi [12]. Veliki vizantijski doktori, od Posejdonija i Oribasija (IV vek n.e.) do Jovana Aktuarija (XIV vek n.e.), ostavili su za sobom mnostvo klinickih opi sa od znacaja za psihijatriju, koje su preuzeli iz dela antickih lekara, po­ sebno Hipokrata (V vek p.n.e.), Galena (II vek n.e.), Areteja (I-II vek n.e.), Sorana iz Efe sa (I-II vek n.e.) i drugih. U njihovim delima je, osim likantro­ pije , opisan i veliki broj drugih mentalnih porernecaja, kao sto su manija, me­ lanholija, katafora (duboka depresija), frenitis, Ijubavna bolest, inkubus (no­ cna mora), letargija, nesanica, senilna atrofija mozga (vrsta demencije), tro­ vanje alkoholom i epilepsija [13] . Matcrijal Prvi vizantijski lekar koji se bavio 1ikantropijom nije bio Ecije, kako tvrde neki autori [14] , vee Oribasije (IV vek n.e .), koji je napisao prvo po­ glavlje u vizantijskoj medicinskoj literaturi na ovu temu, pod naslovom "0 likantropiji" [15]. Oribasije je pisao da likantropi izlaze nocu, uglavnom se zadrzavaju u blizini grobnica do zore, a njihovo ponasanje je nalik vucjern, Ovakvi bolesnici su mogli da se prepoznaju uz pomoc sledecih znaka i simp­ toma: bledi SU, pogled im je prazan, oci suve i duboko usadene i bez suza. Psihijat. dan. /2005/3712/323-327/ 325 Kontaksakis P. V. Likantropija 11radovima vizantijskih lekara Jezik im je suv i ne mogu da luce pljuvacku, Uvek su zedni, a potkoleniee su im obicno povredene jer se cesto saplicu 0 stvari. Prema Oribasiju, ova bolest je dijagnostikovana kao vrsta melanholije. Lecenje u toku hronicne faze je ukljucivalo smirivanje pacijenta, dugotrajno pustanje krvi dok bolesnik ne bi izgubio svest, kupanje u svezoj (ne i morskoj) vodi, a preporucivalo se uno­ senje tecnosti, Nakon toga, pacijent je tokom tri dana moran da se pridrzava ishrane zasnovane na obranom mleku i da uzima biljni purgativ sueur, sto je ponavljano tri puta (ukupno devet dana). Korisceno je i bilje pornesano sa medom, sto je u to vreme bio uobicajen lek za melanholiju. U akutnoj fazi bolesti, u usi i nozdrve bolesnika ukapavana su uspavljujuca ulja koja su naj­ ceSce sadrzavala opijum. los jedan cuveni vizantijski lekar bavio se likantropijom - Ecije (VI vek n.e.), koji je napisao poglavlje pod naslovom "0 likantropiji, odnosno kinantropij i, prema Marsiliju" [16], opisao je ponasanje bolesnika na isti na­ cin kao Oribasije, dodavsi da likantropi lutaju nocu u februaru, oponasajuci vukove iii pse. Dao je istu klinicku sliku kao Oribasije, dodajuci da su rane na potkolenicama nastale kao rezultat cestih padova i ujeda pasa, i da se ne mogu zaleciti. On je, takode, smatrao da je ova bolest jedan oblik melanholi­ je i predlagao je slican nacin lecenja kao Oribasije. Pridodao je neke nove purgative, kao sto su "sveti lekovi" Rufusa, Arhigena i Justusa. Neposredno pre vecernje krize, on je, takode, preporucivao uspavljujuce i slicne supstan­ ee, posebno opijum, koji se davao iii u obliku ulja kroz nozdrve, iii u nekim retkim slucaj evima per os. Pavle Eginjanin (VII vek n.e.) bio je saglasan sa dva prethodna auto ­ ra. Jedno znacajno poglavlje koje je napisao naslovio je "0 likantropiji ili Likaonu", sto je sa sobom nosilo konotaeije inspirisane grckorn mitologijom [17]. Anonimni pisac [18] jednog poglavlja 0 likantropiji slagao se sa sta­ vovima Oribasija i Ecija, i dodao da su likantropi neuobicajeno mrsavi, sto je karakteristicno za melanholiju. Njihova melanholicna konstitueija je iii mo­ dena iii stecena, nastala kao posledica nesanice, stresnih zivotnih situaeija, lose ishrane ili skrivenih hemoroida, a kod zena zbog prestanka menstrual­ nog ciklusa. Nacin lecenja ove bolesti se, prema ovom autoru, poklapa sa onim za koji su se zalagali raniji vizantijski autori. Takode je preporucivao uopsten o lecenje melanholije, i posebne simptomatske tretmane u slucaju hemoroida (operacija) i menstrualnih anomalija. Na kraju, autor je preporu­ civao diuretike i per spirante. Novija istrazivanja [19,20] pruzaju dokaze da je ovaj anonimni pisac verovatno bio Pavle iz Nikeje, cuveni vizantijski lekar iz VII veka n.e. Mihajlo Psel, lekar i cuveni filozof kasnijeg doba (XI vek n.e.), u svoju pesmu "Carmen de re medica" ukljucio je i opis u to vremc poznatih bolesti [21]. Kratko je primetio da je likantropija ne sarno oblik melanholije, vee i mizantropije, posto je pacijent izolovan od drustva, Bolesnika je opisao kao bledog, potistenog, sparusenog i zapustenog izgleda. 326 Psihijot. dan. /2005/37/2/323-327/ Kontaksakis P. V. Ltkantropija u radovima vizantijskih lekara Poslednji cuveni vizantijski lekar, Jovan Aktuarije (XIV vek n.c.), koji je objedinio znanja svih lekara dugog vizantijskog perioda, bavio se me­ lanholijom u poglavlju "0 melanholicnim bolestima" [18]. U opis je uklju­ cio i slucajeve pojedinaca koji Sll vcrovali da poseduju bozji dar predvidanja buducnosti, iii su se plasili bezopasnih svakodnevnih dogadaja, iii bezrazloz­ no izbegavali drustvo ljudi iii razgovor sa njima, cutljivi, tuzni i povuceni. Opisao je i druge, koji su se iii plasili smrti iii je prizeljkivali, uz misli 0 sa­ moubistvu. Klinicka slika koju je pruzio ista je kao kod ranijih lekara, po­ sebno u slucajevima likantropije, Tvrdio je da bolesnici nocu lutaju po grob­ Ijima i usamljenim mestima, poput vukova, a preko dana se vracaju svojim domovima, gde je njihova ponasanje naizgled normalno. Diskusija Prvi opis likantropije dao je lekar Marsilije Siditski (tj. iz Sidije, grada u Maloj Aziji), koji je bio sledbenik aleksandrijske pneumatske skole i ziveo u Rimu (II vek n.e.). Verina Marsilijevih dela je izgubljena. Medu onima koja su sacuvana, moze se izdvojiti njegovo delo 0 likantropiji iii ki­ nantropiji. U svojoj knjizi koja je sadrzala razna medicinska misljenja 0 me­ lanholiji, Galen je citirao znacajan izvod iz dela svog savremenika Marsilija [22]. Sam Marsilije je likantropiju smatrao jednim oblikom melanholije. Ova bolest je kasnije smatrana zooantropskim delirijumom, posto je pacijent bio uveren da se pretvorio u vuka [3]. Ovu vrstu transformacije vee je opisao Hipokrat [3]. Bila je poznata i u vizantijsko doba, i veliki vizantij­ ski lekar, Aleksandar Tralski (VI vek n.e.), iako nije opisao likantropiju per se, predstavio je nekoliko slucajeva melanholije komplikovane raznim vrs­ tama cudnih fantazija [23]. Konkretno, opisao je pacijente koji veruju da su crepo vi, iii zivotinjske koze , iii petlovi, i imitiraju njihovo kukurikanje. Neki drugi pacijenti su imali fantazije inspirisane grckorn mitologijom; verovali su da su slavuji koji placu jer su izgubili Itija (rnitoloska licnost) iii da su Atlas koji podupire nebeski svod, i plasili se da bi on mogao da padne i unisti i njih same i ceo svet. Oribasije, koji je sastavio prvi medicinski opis likantropije u vizantij­ sko doba, bio je paganin i prihvatio je Marsilijev pristup.
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