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. Klinicki opis i na­ cin lecenja koji su predlozili bili su prilicno slicni, mada su se razlikovali u nekim tackama. Medutim, uticaj starih naroda jos uvek je bio ocigledan dva veka kasnije , kada je hriscanin Ecije gotovo od reci do reci usvojio Marsili­ jeve koncepte i etioloski pristup. Marsilije je isticao da je likantropija men­ talna bolest, a ne stvarni fenornen, posto je nemoguce da se Ijudsko bice fi­ zicki preobrazi u vuka. Bolesnik veruje da se u njemu odigrala rnagicna pro­ mena [3]. Prema tome, Marsilije je ocigledno pokusao da obuzda magijska verovanja svog vremena u korist medicinske realnosti, zastupajuci stay da je likantropija psihoza, a ne magijski preobrazaj, Koncept likantropije su kasnije usvojili islamski doktori; prema 001­ su [14], iz Ecijevih tekstova. Moguce je, medutirn, da su arapski lekari bili Psihijat. da n. /2IJ IJ )/3 7/2/323-327/ 327 Kontaksak is P. V. Likantrop ija 1/ radovima vizantijskih lckara upoznati sa ovom temom preko radova Galena, Oribasija, Pavla iz Nikeje, iii cak Pavla Eginjanina, koji su opisali slicne klinicke slike i cija su dela bila poznata u islamskoj literaturi. Rad kasnijih vizantijskih lekara imao je snaza n uticaj na medicinske koncepte kod Arapa [24]. Razes je doslovce prihvatio misljenj a Vizantinaca; drugi su, kao Abulkasis, dodavali neke elemente tera­ pije kao sto jc kauterizacija glave , metod koji se nije naIazio u vizantijskim iii Galenovim tekstovima. Drugi arapski lekari smatrali su da jc ova bole st nasledna i tesko izleciva [14J. Prcma Doisu [14], likantropija predstavlja dobar primer sindroma iz ovog pcri oda koji su iskljucivo teorijski. Ne postoji nijedan slican opis u srednj ovckovnoj islamskoj literaturi. Prema tome, rnoguce jc da je klinicka slika likantropije izvedena iz grcke medicine [13]. Kasnijc je ovu klinicku sliku prih vatila i zapadnoevropska medicina, i to iIi direktno iz vizantijskih mcdicinskih tek stova iii, sto je cesci slucaj, posrcdno, preko prevoda arap­ skih tekstova na latinski [13J. Cini se da je ova bolest, koju karakterisu Iutanje oko grobnica preko noci i vracanje u svakodnevnu rutinu preko dana, slicna mitu 0 vampirima, koji se moze naci u mnogim kulturama sirorn sveta [25]. Da zakljucimo: mnogi vizantijski Iekari detaIjno su opisali klinicku sliku likantropije. Neki osnovni simptomi ovog porernecaja, kao sto je drus­ tvena izolacija, rnizantropija, potisteno st i nemar prema spoljasnjem izgledu, ubrzo su ih naveIi da ovo stanje klasifikuju kao mentalni poremecaj , u skla­ du sa shvatanjem Marsilija, koji ga je prvi opisao. Preciznije, vizantijski Ie­ kari kIasifikovali su likantropiju kao oblik depresije (melanholicni tip, ili psihoticna depresija). Treba napomenuti da ni Marsilije, iako je bio paganin, ni hriscanski vizantijski doktori, nisu verovali da je ovaj poremecaj magij­ skog iii demonskog porekla, vee su smatrali da je rec 0 dusevnoj bolesti. Njihovi stavovi su neposredno ili posredno utical i na arapsku i zapadnoev­ ropsku medicinu.

Psihijat. dan. /200513712/329-334/ 329 Kontaxak is P. V. Lycanthropy according to Byza ntine physicians

General article UDK: 616. 89 - 008 (495.02) 616. 89 (091)

'li~,.A.//

LYCANTHROPY ACCORDING TO BYZANTINE PHYSICIANS

t Vassilis P. Kontaxakis', 'J ohn G. Lascaratos", Panayotis P. Ferentinos', Maria-Irini V. Kontaxaki', George N. Christodoulou'

IDepartment ofPsychiatry, University ofAthens, Greece 2History ofMedicine, University ofAthens, Greece

Abstract: The purpose of this paper is to review texts about lycanthropy in Byzantine medical literature and to appreciate their impact on medicine thenceforth. The original Greek language texts of the Byzantine physicians, such as Oribasius (4th century A.D.), Aetius (6th century A.D.), Paul of Aegina (7th century AD.), Paul of Nicea (7th century A.D.), Micha el th Psellus (II th century AD.) and Joannes Actuarius (14 century AD.), were examined. The existing texts of ancient Greek and Roman physicians were also reviewed . Byzantine physi­ cians provided detailed descriptions of the clinical picture of lycanthropy as well as sugges­ tions about its treatment. They believed lycanthropy to be a form of melancholic or psychotic depression and not demonic in origin, being in line with the Roman physician Marcellus Sid­ ites (2nd century A.D.), who first described the syndrome. The views of Byzantine physic ians about lycanthropy have directly or indirectly influenced the way Arabic and Western European medicine have later dealt with it.

Key words: Byzantine medicine, history ofmedicine, lycanthropy, depression, melan­ choly, psychosis 330 Psihijat. dan. /2005/37/2/329-334/ Kontaxakis 1'. V. Lycanthropy according 10 Byzantine physicians

Introduction Lycanthropy is the delu sional belief of having been transformed into an animal, traditionally a wolf [1,2]. The term lycanthropy originated from the Greek words lycos = wolf and anthropo s = man. The first descripti ons of the syndrome can be found in Greek mythology. Demigod Lycaon was trans­ formed by Zeus into a wolf as a punishment for his attempt to feed Zeus with the t1esh of a young boy he had sacrified [3]. A later description of the syn­ drome is found in the Bible. In the Book of Daniel a divine punishment was inflicted upon the Babylonian King Nebuchadnezzar; he was transformed into an ox for seven years [4,5]. In the beginning of the 19th century lycanthropy was considered as a mental disorder [6]. During the 20th century, several case reports of lycan­ thropy were publi shed in the international literature. Most of them concerned patients sufferin g from affective or psychotic disorders. Further cases of man-animal metamorphoses were reported in patients with other mental dis­ orders, including personality disorders, hysteria, alcohol or drug abu se, or­ ganic brain syndromes, dem entia, and epil epsy [7-11]. The purpose of this study is to show that the works of Byzantine physi­ cians on lycanthrop y provided new data and offered clearer interpretations of this condition; moreover, they provide evidence that since ancient times lycanthropy had been thought to be a mental diseas e. Byzantine medicine is, in fact , the continuation of anci ent Greek, Hellenistic and Roman medical tradition, as well as the vital link to Western Euro pean medi cine , which it influenced directly or indirectly, via the works of Arab physicians. The investigation of the writings ofByzantine physici ans is of significant interest because most of them reproduce the essence of the writ­ ings of ancient Greek physicians, many of which are now lost, without failin g to supply their own contribution at the same time [12]. The great Byzantine doctors , from Possidonius and Oribasius (4th century A.D.) to Joannes Actu­ arius (14th century A.D.), provided many clinical descriptions of psychiatric in­ terest, which they compiled from the works of ancient physicians, especially th nd nd Hippocrates (5 century B.C.), Galen (2 century AD.), Aretaeus (lsl_ 2 cen­ nd tury AD.), Soranus from Ephesus (1 st _ 2 century A.D.) and others. Apart from lycanthropy, a series of other mental disorders were described in their works, such as mania, melancholy, cataphora (profound depression), phrenitis, love­ sicknes s, incubus (nightmare), lethargy, insomnia, senile cerebral atro­ phy (a type of dementia), alcoholic intoxication and epilepsy [13].

Material The first Byzantine physician to deal with lycanthropy was not Aetius, as referred to by some authors [14] , but Oribasius (4th century A.D .), who wrote the first chapter of Byzantine medical literature on this topic, entitled "On Lyc anthropy" [15]. Oribasius wrote that lycanthropes circul ate at night, usually stay around tombs until dawn, and behave exactly like wolves. The Psihi j at. dan,/2005/37/2/329-334/ 331 Kontaxakis 1'. V. Lycanthropy according to Byzantine physicians recognition of these sufferers was achieved by notin g the following signs and symptoms. They are pale and gaze vacantly with dry eyes deep in their sockets, without producing tears. Their tongue is dry and they do not produce saliva at all. They are always thirsty and their shins are usually injured be­ cause they often stumble against objects. According to Oribasius the dis­ ease was diagnosed as a form of melancholy. The treatment during the chronic phase included calming the patient, extended venesection until the sufferer fainted, baths in fresh (non-salt) water, while fluid-intake was encour­ aged. Later on, a fat-free milk diet and holy marrow herb purgatives were administered for three days. This was repeated three times (a total of nine days). Then, theriac-containing snakes, the usual remedy for melancholy in that time, were administered. In the acute phase ofthe disease, somniferous inunctions into the ears and nostrils, most often containing opium, were used. The second eminent Byzantine physician dealing with lycanthropy was Aetius (6th century A.D. ), who wrote a chapter entitled "On Lycan­ thropy, that is cynanthropy, according to Marcellus" [16]. Aetius described the behavior of sufferers in the same way as Oribasius and added that lycan­ thropes wander at night in February, imitating wolves or dogs. He provided the same clinical picture as Oribasius, adding that the wounds of the shins are due to repeated falls and dog bites and are incurable. He also considered the disease as a form of melancholy and suggested a similar treatment as Oribasius. He went on to add some new purgatives, such as the "holy drugs" of Rufu s, Archigenes and Justus. Before an imminent evening crisis, he also recommended soporifics and similar substances, in particular opium, administered either as inunctions into the nostrils or in some rare cases per os. Paul of Aegina (7th century A.D.) was in line with the two previous authors. He entitled his relevant chapter "On Lycanthropy or Lycaon", implying connotations inspired from Greek mythology [17]. Another anonymous writer [18] of a chapter on lycanthropy agreed with the ideas of Oribasius and Aetius and added that lycanthropes are un­ usually slim, which is a characteristic ofmelancholy. Their melancholic con­ stitution is either congenital or acquired, resulting from insomnia, life stressors, bad diet or blind hemorrhoids and, in women, a cessation of the menstrual cy­ cle. According to the author, the treatment of the disease coincided with that advocated by earlier Byzantine writers. He further recommended general treatments of melancholia and special causative treatments in cases of hemor­ rhoids (surgery) and menstrual anomalies. Finally, the author suggested diu­ retics and perspirants. Recent researches [19,20] have provided evidence that the anonymous writer was probably Paul ofNicea, an eminent Byzantine physician ofthe 7thcentury A.D. A later physician and eminent philosopher, Michael Psellus (11th ~ century A.D.), included in his poem "Carmen de re medica" a description of I the known diseases in that time [21]. He noted briefly that lycanthropy is not only a form of melancholy but also misanthropy, since the patient is isolated 11 1 332 Psihi j at. dan. /2005/37/2/329-334/ Kontaxakis P. V. Lycanthropy according to Byzantine physicians from society. He de scribed the sufferer as pale, dejected, dry , and care­ less of his appearance . The last famous Byzantine physician, Joannes Actuarius (l4th century A.D.), who summarized the knowledge of all the physicians of the extensive Byzantine period, dealt with melancholy in his chapter "On Melancholic Dis­ eases" [18]. He included cases of individuals believing that they had the di­ vine gift of forecasting the future, or fearing harmless everyday events, or un­ reasonably avoiding the company of or conversation with people, remaining silent, sad and withdrawn from society. Finally, he described others who either feared death or desired it, having suicidal thoughts. In lycanthropy cases, in particular, he provided the same clinical picture as earlier physicians. He argued that at night sufferers wander around cemeteries and lonely places like wolves; while during daytime they return to their homes, where their behavior is apparently normal.

Discussion The first description of lycanthropy was given by the physician Mar­ cellus Sidites (i.e. from Sydia , a town in Asia Minor), who was a follower of the Pneumatic School of Alexandria and lived in Rome (2nd century A.D.). Most of Marcellus' works have been lost. Among the remaining ones, his work on lycanthropy or cynanthropy can be singled out. Galen quotes a relevant extract of his contemporary Marcellus' work in his bo ok containing various medical opinions on melancholy [22]. Marcellus himself consid­ ered lycanthropy to be a form of melancholy. The disease was later considered to be zooanthropic delirium, as the patient thought he had been transformed into a wolf [3]. Thi s kind of trans­ form ation had already been described by Hippocrates [3]. It was also known in Byzantine times, as a great Byzantine physician, Alexander of Tralles (6th century A.D.), presented several cases of melancholy complicated with dif­ ferent kinds of strange fantasies, although he did not describe lycanthropy per se [23]. In specific, he described patients who believed they were roof­ tiles, or animal skins, or cockerels, imitating their crowing. Some other pa­ tients had fantasies inspired from Greek mythology; they believed they were nightingales crying because they had lost Itis (a mythological figure) or they believed they were Atlas supporting the globe, fearing that it might fall and de­ stroy themsel ves and the whole world. Oribasius, who compiled the first medical description of lycanthropy in Byzantine times, was a pagan and he adopted Marcellus' approach. The clinical description and treatments they proposed were quite similar, although different in some points. However, the influence of the ancients was still evi­ dent two centuries later, when the Christian Aetius adopted, almost verba­ tim, Marcellu s' concepts and etiological approach. Marcellus pointed out that lycanthropy was a mental disease and not a real phenomenon, as it is impossi­ ble for a human being to be transformed physically into a wolf. The sufferer Psihi j at. dan./2005/37/2/329-334/ 333 Kontaxakis P. V. Lycanthropy according to Byza ntine physicians believes that a magical change has taken place within him [3]. Thus, Marcellus obviously harnessed the magical beliefs of his time to the medical reality, ad­ vocating that lycanthropy is a psychosis and not a magical transformation. The concept of lycanthropy was later adopted by Islamic doc­ tors; according to Dols [14], from the work of Aetius. It is, however, possi­ ble that Arab physicians could have known this from the works of Galen, Oribasius, Paul ofNicea or even Paul of Aegina, who described similar clinical pictures and whose works were known in the Islamic literature. The work of the later Byzantine physician s deeply influenced the medical concepts of the Arabs [24]. Razes adopted verbatim the opinions of the Byzantines; others like A bulc asis added some therapeutic elements such as cauterization of the head, a method not included in Byzantine or Galenic texts. Other Arab physicians considered the illness inherited and hardly curable [14]. According to Dols [14], lycanthropy represents a good example ofthe purely notional syndromes ofthis period. No similar description in the medieval Islamic literature exists. Thus, it is possible that the clinical picture of lycan­ thropy was derived from Greek medicine [13]. Later, this clinical picture was adopted by Western European medicine either directly from the Byzantine medical texts or, mainly, indirectly from translations of the Arabic works into Latin [13]. It seems that the disease, characterized by wandering around tombs at night and returning to everyday routine during daytime, resembles the myth of vampires, which can be found in many cultures worldwide [25] . In conclusion, many Byzantine physicians have described the clini­ cal picture of lycanthropy in detail. Some main symptoms of the disorder, such as social isolation, misanthropy, dejection and carelessness of one's ap­ pearance , have led them to early classify this condition as a mental disorder, in line with the concepts of Marcellus, who first described it. In specific, Byzan­ tine physicians have classified lycanthropy as a form of depression (melan­ chol ic type or psychotic depression). It is worth noting that neither Marcel­ lus, though a pagan, nor Christian Byzantine doctors thought that the disor­ der was magical or demonic in origin, and they believed it to be a mental ill­ ness. Their views have directly or indirectly influenced Arabic and Western European medicine.

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Doc. dr Vasilis P. KONTAKSAKlS, Univerzitet u Atini , Psihijatrijsko ode­ Ijenje bolnice "Eginition", Grcka

Vassilis P. KONTAXAKlS, MD, PhD, Associate Professor of Psychiatry, University ofAthens, Greece E-mail: [email protected]